Get Paf

Filling out the Pharmion™ Prescription Authorisation Form (Paf) is an essential step for patients and healthcare providers involved in the Pharmion™ Pregnancy Prevention Programme. This guide provides thorough instructions to ensure the form is accurately completed and submitted online.

Follow the steps to complete the Paf online effectively.

1. Press the ‘Get Form’ button to access and open the Paf in your online editor.
2. Fill in the patient's initials and date of birth in the provided fields ensuring accuracy.
3. Indicate the diagnosis of the patient clearly in the designated section.
4. Enter the prescriber's first and last name in the appropriate fields.
5. Select the correct patient category by ticking the corresponding box, either 'Woman of non-childbearing potential', 'Male', or 'Woman of childbearing potential', then fill in the additional requested information.
6. For male patients, confirm whether they have been counseled about the teratogenic risk of Pharmion™ by selecting 'Y' or 'N'. A 'Y' response is necessary for the prescription to be dispensed.
7. For female patients of childbearing potential, confirm that they have been counseled about the risks and have been using an effective method of pregnancy prevention for at least 4 weeks. Select 'Y' or 'N' accordingly.
8. Enter the date of the last pregnancy test in DD, MM, YYYY format.
9. Indicate if the last pregnancy test result was negative by marking 'Y' or 'N'. Note that a 'Y' answer is required, and the test must have been performed within 3 days of the prescription date.
10. The prescriber must sign and date the form to confirm the patient has signed the Treatment Initiation Form and that the prescription is for a maximum of 4 weeks.
11. Finally, the pharmacist must complete their section by including their first and last name, signature, and date while confirming that the form has been filled out correctly and that all conditions for dispensing have been met.
12. Once completed, save the changes to the document, and you can download, print, or share the form as necessary.

Ensure your documents are correctly filed online to keep your health and safety a priority.