Follow the steps to successfully complete your authorization request.

1. Press the ‘Get Form’ button to download the Special Authorization Request form and open it in your editor.
2. In Section 1, enter the patient's information, including their surname, Green Shield ID number, employer name, first name, date of birth, telephone number, street address, city, province, and postal code.
3. Provide the patient's consent for healthcare providers to share relevant health information needed for the authorization process. This is crucial for assessing eligibility.
4. In Section 2, the physician must fill in their information, including their name, signature, specialty, address, province, postal code, telephone number, date, and fax number.
5. In Section 3, specify the drug requested for evaluation by detailing the product name, strength, dose, and duration of treatment. Additionally, indicate the injectable location and provide a diagnosis.
6. Include the previous therapeutic history relevant to the condition, along with any lab results that support the request.
7. If applicable, mention any prior treatment results and additional comments that could assist in evaluating the medication request.
8. In Section 4, confirm whether the patient is enrolled in a patient assistance program, including details like the program name and contact information.
9. Recheck all entries for completeness and accuracy to avoid delays in processing.
10. Once the form is fully completed, it can be printed, faxed, or emailed to the Drug Special Authorization Department according to the provided mailing instructions.

Complete the Canada GSC Prescription Drug Special Authorization Request online today for a smoother approval process.