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Multiple Sclerosis Medications Program Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/multiple_sclerosis_medications_program_special_authorization_request_form.pdf
2017-12-15
Multiple Sclerosis Special Authorization Request Form to be  completed by your neurologist.
SPECIAL AUTHORIZATION REQUEST MULTIPLE SCLEROSIS Fax requests to (902) 368-4905 OR mail requests to PEI Pharmacare, P.O. Box 2000, Charlottetown, PE, C1A 7N8...

Out-of-Province Travel Declaration Form

https://www.princeedwardisland.ca/sites/default/files/publications/out_of_province_travel_declaration.pdf
2017-10-02
PEI Pharmacare  clients travelling outside of the province may be allowed to obtain up to 180 days of their eligible medication prior to leaving the province. If your medication is eligible, complete this form prior to leaving the province and take it to your pharmacy, so they can keep it on file....
    PEI PHARMACARE OUT OF PROVINCE TRAVEL DECLARATION   Name:  Days’ Supply Needed (max. 180 days)   Personal Health Number (“PHN”)  Note: Your pharmacist cannot determine the days’  supply that is eligible for Pharmacare coverage. Please ...

Request to Correct Personal Health Information Form

https://www.princeedwardisland.ca/sites/default/files/forms/request_to_correct_personal_health_information_form.pdf
2017-07-20
Complete this form to request a correction to your personal health information.  
Microsoft Word - Request to Correct Personal Health Information.docx   Request to Correct Personal Health Information    Personal information on this form is collected under authority of Prince Edward Island’s Freedom...

Insulin Pump Program: Family Contribution Assessment and Release of Information Form

https://www.princeedwardisland.ca/sites/default/files/forms/insulin_pump_program_family_contribution_assessment_and_release_of_information_form.pdf
2017-05-02
Complete this form to register for the Insulin Pump Program. Include a recent, certified copy, of your, Canada Revenue Agency Income Tax Return, from the previous year for you and your spouse, if applicable.
April, 2017 PEI Insulin Pump Program Family Contribution Assessment and Release of Information This Application is for… (Check all that apply) New Pump OR Replacement pump (current pump...

Health Care Directive Form

https://www.princeedwardisland.ca/sites/default/files/publications/health_care_directive_form.pdf
2017-04-12
You can use this form to set out your wishes or instructions for your health care and treatment in case a health care practitioner has determined that you are, not, capable to either make and/or communicate your own health care choices.   In your Health Care Directive, you can appoint a person or...
Health Care Directive / Directive relative aux soins de santé 14HPE15-40623 For assistance in providing a Health Care Directive, please see the notes section. Si vous avez besoin d’aide pour donner une directive relative aux soins de santé,...

Atlantic Psychiatric Conference brochure and registration form

https://www.princeedwardisland.ca/sites/default/files/forms/annual_atlantic_psychiatric_conference_brochure_and_registration_form.pdf
2017-04-04
Information about the Annual Atlantic Psychiatric Conference including topics, presenters and how to register.
3 Brochure 2017.pub A D V A N C E R E G IS T R A T IO N -U N T IL M a y 5 , 2 0 1 7 2 -D a y : $ 3 0 0 .0 0 A F T E R M a y 5 , 2 0 1 7 2 -D a y : $ 3 5 0 .0 0 T o b e co n sid ered reg istered , yo u r reg istra tio...

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