Form
Diabetes Referral Form
Complete this form to refer or self-refer to the Provincial Diabetes Program or the Diabetes Drug Program.
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Displaying 1 - 10 of 15 records
Form
DPP-4 / SGLT2 Inhibitors Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Rheumatoid Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Psoriatic Arthritis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Enfuvirtide Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Crohn's Disease Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Ankylosing Spondylitis Special Authorization Request Form
Special authorization request form to be completed by your physician or diagnosing specialist.
Form
Family Health Benefit Application Form
Complete this form to apply for the Family Health Benefit Drug Program.
Form
High Cost Drug Program Application Form
Complete this form if you need assistance paying for expensive medications. You may be eligible for coverage of approved medication costs through the High Cost Drug Program.
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.