Get Permohonan Memperolehi Menggunakan Ubat Yang Memerlukan

This guide provides a comprehensive overview of the process for completing the PERMOHONAN MEMPEROLEHI MENGGUNAKAN UBAT YANG MEMERLUKAN form online. Users will find detailed step-by-step instructions to help ensure successful submission of their application for special drug approval.

Follow the steps to successfully complete the application form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Fill in the hospital name and the hospital's application number in the designated fields.
3. Provide the name of the medication sought, including the generic name, strength, and dosage form.
4. Indicate the state where the application is being submitted.
5. Specify the registration status of the medication with the Drug Control Authority, as per the provided guidelines.
6. Input the patient's name and identification card number along with their age.
7. Detail the patient's diagnosis information.
8. Complete the application type, including whether it is a new application or a repeat application.
9. Outline the dosage regime and treatment duration, alongside the patient's weight.
10. List the quantity needed, specify the unit cost and calculate the total cost, ensuring to attach quotation details.
11. Fill out the sections regarding treatment indications for the requested medication.
12. Provide a summary of the patient's treatment history and any alternative treatments previously used.
13. Include the signatures, names, and seals of the requesting doctor, the head of department, and the chief pharmacist.
14. Submit the required attachments as indicated in the checklist, ensuring all relevant documents are marked accordingly.
15. Once all fields are completed, save the changes, and choose to download, print, or share the form as necessary.

Start your application by filling out the form online today!