Form
Ostomy Supplies Claim Submission Form
This form is used to submit a claim to the Ostomy Supplies Program.
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Displaying 1 - 10 of 25 records for "pharmacare"
Form
Home Oxygen Program Application Form
Complete this form if you have been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and have been prescribed oxygen. You may be eligible for coverage of expenses through the Home Oxygen Program.
Form
Rheumatoid Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Plaque Psoriasis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Ostomy Supplies Program Registration - Health Care Provider Form
Your health care provider must complete this form as part of the application process for the Ostomy Supplies Program.
Information
Substance Use Harm Reduction Drug Program
If you are an Islander seeking treatment for opioid use disorder or alcohol use disorder, you may be eligible for coverage of approved medication costs through the Substance Use Harm Reduction Drug Program effective June 1, 2022. Am I eligible? You are eligible for the program if...
Form
Erythropoietin Program Approval Form
Complete this form if you have been diagnosed with chronic renal failure, or are receiving kidney dialysis. You may be eligible for coverage of anemia treatment medications, which will eliminate the need for frequent blood transfusions.
Form
Enfuvirtide Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Diabetes Referral Form
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program.