Résultats de la recherche

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Résultats 1 à 16 sur un total d 16 .

Résultats

DPP-4 / SGLT2 Inhibitors Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/dpp-4_sglt2_inhibitors_special_authorization_request_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
SPECIAL AUTHORIZATION REQUEST DPP-4/SGLT2 INHIBITORS Fax requests to (902) 368-4905 OR mail requests to PEI Pharmacare...

Enfuvirtide Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/enfuvirtide_special_authorization_request_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
FORMS WITH INFORMATION MISSING WILL BE RETURNED FOR COMPLETION. APPROVALS WILL NOT BE CONSIDERED AT DOSES OR DOSING INTERVALS OUTSIDE OF PEI GUIDELINES. SPECIAL AUTHORIZATION REQUEST ENFUVIRTIDE (FUZEON) Fax requests to (902) 368-4905 OR mail...

Idiopathic Pulmonary Fibrosis Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/idiopathic_pulmonary_fibrosis_special_authorization_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
SPECIAL AUTHORIZATION REQUEST IDIOPATHIC PULMONARY FIBROSIS Fax requests to (902) 368-4905 OR mail requests to PEI Pharmacare, P...

Low Molecular Weight Heparin Special Authorization Request Form

https://www.princeedwardisland.ca/sites/default/files/forms/low_molecular_weight_heparin_special_authorization_request_form.pdf
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.  
SPECIAL AUTHORIZATION REQUEST LOW MOLECULAR WEIGHT HEPARIN Fax requests to (902) 368-4905 OR mail requests to PEI Drug Programs, P.O. Box 2000, Charlottetown, PE, C1A 7N8 SECTION 1 – PATIENT...

Special Authorization Request for Coverage of High Cost Cancer Drugs 1

https://www.princeedwardisland.ca/fr/formulaire/special-authorization-request-coverage-high-cost-cancer-drugs-1
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.

Special Authorization Request for Coverage of High Cost Cancer Drugs 2

https://www.princeedwardisland.ca/fr/formulaire/special-authorization-request-coverage-high-cost-cancer-drugs-2
2016-03-02
Special authorization request form to be completed by your physician or diagnosing specialist.
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Ministères et organismes

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