Get Eap Oxyneo

The Exceptional Access Program (EAP) Request Form for HCl Controlled Release Tablets (OxyNEO) facilitates access to necessary medications for patients. This guide provides clear, step-by-step instructions on how to effectively complete the online form, ensuring that all relevant information is accurately provided.

Follow the steps to complete your Eap Oxyneo request.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Fill out Section 1 - Prescriber Information. Enter the prescriber's first name, initials, last name, contact details, including mailing address, fax number, and telephone number.
3. In Section 2 - Patient Information, provide the patient's first name, middle initial, last name, health number, mailing address, date of birth, and indicate if it is a new request or a renewal. You may also include any existing EAP request number, if applicable.
4. Complete Section 3 - Drug Requested by selecting the requested strength(s) of hydrochloride CR (OxyNEO) tablets. Specify the dose and frequency, and indicate the duration of treatment.
5. If applying for OxyNEO through EAP for the first time, fill out Section 4 - Diagnosis and Reasons(s) for Use. State the patient's diagnosis, confirm if it is a chronic condition, and ensure all applicable questions for EAP's reimbursement criteria are answered.
6. In Section 5 - Medication: Current and/or Previous, list any long-acting opioid products previously taken by the patient, their corresponding usage details, and the reasons why these alternatives are deemed inappropriate.
7. Ensure the prescriber’s signature and CPSO number are included. Then, note the date of completion in the required format.
8. Submit the completed form by faxing or mailing it as specified in the instructions, ensuring to include any additional relevant information, if necessary.
9. Review all entered information for accuracy before saving the changes. Users can download, print, or share the finalized form as needed.

Complete your Eap Oxyneo request online today to ensure prompt access to necessary medications.