Get Exception Drug Status Request Form - Saskatchewan - Formulary Drugplan Health Gov Sk

This guide provides comprehensive instructions on how to accurately complete the Exception Drug Status Request Form for Saskatchewan's Formulary Drugplan. By following these steps, users can ensure their form is filled out correctly and submitted efficiently.

Follow the steps to effectively fill out your request form.

1. Press the ‘Get Form’ button to access the Exception Drug Status Request Form and open it in your preferred editor.
2. Fill out the patient identification section by providing the patient's name, health services number, address, date of birth, and sex.
3. In the drug information section, specify the drug(s) requested, including the name, dosage form, and strength. Ensure to reference Appendix A for specific criteria.
4. Clearly state the diagnosis, which must be obtained from the prescribing physician or their agent, not from the patient.
5. Indicate how the diagnosis was obtained by selecting one of the following: fax, phone, or written on prescription (Rx).
6. List any alternative agents tried, detailing the names of the medications.
7. Document any drug allergies and intolerances, ensuring specificity and clarity.
8. Add any other information relevant to the request that may assist in the approval process.
9. Complete the sections designated for pharmacy use only, including the pharmacist's name, pharmacy name, and phone number.
10. Enter the prescribing physician's details, including their name, M.S.P. number, and phone number, as well as any locum information if applicable.
11. Finally, review all the information provided for accuracy. Once satisfied, save changes, and download or print the completed form as needed.

Complete your Exception Drug Status Request Form online today for efficient processing.