Get Ministry Of Health Non-formulary Drug Request Form For A ...

Filling out the Ministry of Health Non-Formulary Drug Request Form is a crucial step in ensuring that patients receive necessary medications that are not included in the standard formulary. This guide provides detailed instructions on how to complete the form accurately and effectively within an online environment.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it for editing.
2. In Part A: Patient Information, fill in the medical record number, indicate whether the patient is an inpatient or outpatient, and provide the patient's name, date of birth and age, gender, nationality, and contact number.
3. In Part B: Requester Information, enter the prescriber's name, specialty, practicing license number, designation, department, health facility name, medical district, emirate, contact phone number, and email ID.
4. In Part C: Pharmaceutical & Clinical Information, specify the request status (new, repeat, or refill) and provide the generic name of the requested drug. Fill in the dosage form, strength, dose, expected duration of treatment, and route of administration.
5. Indicate the urgency of the treatment required by selecting from emergency, urgent, soon, or non-urgent categories. Specify the diagnosis or indication for the requested drug.
6. Answer whether the requested drug has been approved for the given indication by relevant regulatory authorities, such as US-FDA or EMEA, and provide reasoning for the request if necessary.
7. Complete the requester’s declaration by signing and dating the form, ensuring that all relevant information is accurate.
8. If applicable, have the patient sign the patient’s declaration section, or have a bystander sign on their behalf.
9. Have the in-charge pharmacist sign their declaration on the request form.
10. In Part D: Request Review Report, ensure any necessary review questions have been completed and provide feedback from reviewers as needed.
11. Finally, in Part E: Decision, the review decisions should be noted along with signatures where applicable.
12. After finishing all sections, users can save changes, download, print, or share the filled form as required.

Complete your non-formulary drug request form online to ensure timely and effective treatment for your patients.