Get Exceptional Access Program (eap)

This guide provides a clear and supportive overview for users filling out the Exceptional Access Program (EAP) form online. Follow these detailed steps to ensure that all necessary information is accurately recorded.

Follow the steps to complete your Exceptional Access Program (EAP) form online.

1. Click ‘Get Form’ button to obtain the EAP form and open it in your chosen digital editor.
2. In Section 1, provide physician information, including the physician's initial, first name, and street address.
3. In Section 2, fill in patient information, including the last name, first name, initial, Ontario Health Insurance Number, street name, city, postal code, gender, current weight, fax number, and telephone number. Specify the request type as either 'Initial Request' or 'Renewal Request', depending on the patient's situation.
4. In Section 3, list the drugs, doses, and regimens requested. Be sure to indicate the dosage and frequency of administration accurately. If you require additional space, attach extra sheets.
5. For Section 4A and Section 4B, record information regarding the diagnosis of active rheumatoid arthritis. Ensure to document swollen joint counts and any required clinical markers.
6. In Section 5, detail any previous or current disease-modifying anti-rheumatic drugs (DMARD) and biologic therapies, including dosing regimens, start and end dates, and reasons for discontinuation.
7. At the end of the form, obtain the physician's signature along with their CPSO number and the date.
8. Finally, review all sections for completeness, then you can save changes, download, print, or share the form as necessary.

Complete your Exceptional Access Program (EAP) form online now to ensure timely processing.