Medication Coverage
Collection of Special Authority forms/drug coverage forms/etc - Special Authority Forms are now being rejected (Feb 2015) unless there is a 'wet' signature. Forms have been updated to reflect this. Also an attempt was made to increase font size where possible to improve legibility.
- Special Authority Request Form - Low Molecular Weight Heparin for DVT prophylaxis in cancer patients 2018
- This is a new form as of 2018 from the BC Ministry of Health for DVT Prophylaxis for Cancer patients.
- Special Authority Request Form - Low Molecular Weight Heparin for DVT prophylaxis and treatment 2018
- This is a new form created by the BC Ministry of health in October of 2018
- SPECIAL AUTHORITY REQUEST APIXABAN / DABIGATRAN / RIVAROXABAN FOR ATRIAL FIBRILLATION
- Special Authority Form for anticoagulants for Atrial fibrilation
- Special Authority Request - Generic Form 2017
- Updated because of Changes to the Cholinesterase Inhibitor forms.
- Special Authority Forms Updated August 2016
- Created by John Yap - Antivirals for Chronic Hep C, and New SA form for PPIs.
- BC Special Authority Forms September 2015
- **CI's removed in favour of 2017 version**Oral Diabetes agents, Cholinesterase Inhibitors, Long Acting Muscarinig Agonists -- Pharmacare Special Authority Request for pharmacare coverage of prescribed medications. Updated September 2015 by John Yap. Now includes signature area and updated web pages --- Includes low molecular weight heparin, oral glucose lowering agents, Cholinesterase inhibitors and Long Acting Muscarinic Agonists (LAMAs)
- Special Authority Plan G Form BC February 2016
- Edited to fit with other forms and menu added. Please delete the previous PlanG eform prior to uploading this one. It will not upload if there is an eform with the same name already present. For special Authority Psychiatric Medication. Includes a link to the web page for prescribers, calendars, a signature area, and conversion of current user from Lastname, Firstname to Firstname Lastname.
- Special Authority BC COPD 2016
- Special Authority Form for COPD for BC updated February 18th 2016 supplied by OSCARWest
- BC Special Authority for Ticagrelor
- BC Fair Pharmacare funding for Ticagrelor. Created by JohnY
- Special Authority Cholinesterase Inhibitor (CI) DONEPEZIL, GALANTAMINE AND RIVASTIGMINE February 2017
- Replaces 2015 version - From JohnY - The new Cholinesterase inhibitor Special Authority form replaces the initial, switching, and renewal eForms! All 3 of the CI eForms were referenced in the general Special Authority eForm. So that one had to be updated too
- BC Palliative Care Benefits Registration March 2017
- The form has been updated to conform with the latest requisition. It has the SPICT tool to help with filling out the form. It has links to the various government web sites. Built on the 2015 version - Updated November 17th 2015 - signatures improved, button for MD Decision Maker. --- Created using the latest eform generator. Has signature fields, x boxes, links to outside web pages, and a side menu that allows for insertion of the necessary diagnoses. There is a link to the original 3 page fillable pdf so that the instructions can be reviewed. JohnR. Updated Sep23_2017 for Pathways. Minor cosmetic tweaks. Addition of font-size-changer, if you need to squeeze in more details. Dash of colour too! JohnY
- Special Authority Filgrastim SA_Filgrastim_V1_Mar29_2018.zip
- Requires creation of ANC measurement, and mapping to absolute neutrophil count. May need OSP support to do this. --- To create the measurement and map it look at the tutorial here: http://oscarcanada.org/about-oscar/presentations/measurements-in-oscar/view? The LONIC code for Absolute Neutrophil Count is 751-8
- Special Authority Form for ADHD 2018
- BC Special Authority form for ADHD medication coverage
- Special Authority Form for Basal Insulins: SA_Basal_Insulin_V1_Feb1_2019.zip
- Special Authority Request form SGLT2 - Empagliflozin
- From John Yap - I have made version 2 now - which looks for existing Rx of a Gliptin, because you can't have both. Approving the SGLT2 will cancel the previous approval for DDP4. The warning is new to V2.
- Updated 2018 donepezil special authority form
- Updated 2019-Nov-25 12:01 Cholinesterase inhibitors. Thanks to Dr. Robin Patyal
- Special Authority Request PPI updated Nov 2019
- Updated by Dr. Yap
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