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Résultats 1 à 10 sur un total d 21 .

Résultats

Adult Speech and Language Pathology Case History Form

https://www.princeedwardisland.ca/sites/default/files/forms/adult_speech_language_case_history_form.pdf
2016-03-30
Case history to be completed before your initial visit to Speech Language Pathology
Please use additional paper if required to provide detailed information. Adult Speech and Language Pathology Case History Name:...

Hillsborough Hospital Volunteer Services Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/hillsborough_hospital_volunteer_application_form.pdf
2016-03-16
Complete and submit the Hillsborough Hospital Volunteer Services Application Form to volunteer at Hillsborough Hospital.
C:\Documents and Settings\gemacdonald\Local Settings\Temp\Volunteer Application Form Final.wpd VOLUNTEER SERVICES Hillsborough Hospital PO Box 1929 Charlottetown, PE C1A 7N5 Phone: 368-5466 NAME...

Trousse du TIF – Formulaire de demande

https://www.princeedwardisland.ca/sites/default/files/forms/trousse_du_tif_-_formulaire_de_demande.pdf
2016-03-03
Si vous êtes âgé de moins de 50 ans ou de plus de 74 ans ou courez des risques élevés, veuillez demander à votre médecin ou infirmière quel moyen de dépistage serait le meilleur pour vous. Si vous avez entre 50 et 74 ans, veuillez remplir le présent formulaire pour obtenir la trousse du FIT afin de...
Microsoft Word - FIT June 2015_1.docx FIT Home Screening Test Request Form Thank you for your interest in a home screening test. The PEI Colorectal Cancer Screening Program is for Islanders aged 50-74 years of age who are of average risk for...

Ankylosing Spondylitis Special Authorization Request Form

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

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...

Family Health Benefit Application Form

https://www.princeedwardisland.ca/sites/default/files/forms/family_health_benefit_application_form_0.pdf
2016-03-02
Complete this form to apply for the Family Health Benefit Drug Program.
Family Health Benefit Personal Information (please print) Applicant Spouse (if applicable) Surname Surname First Name Initial First Name Initial PEI Health Care Card number (PHN) PEI Health Care Card number (PHN) Date...

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.

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