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Brenzys (Etanercept) - Rheumatoid Arthritis & Ankylosing Spondylitis - Patient Support Program (Updated May 2019)
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Breo Ellipta 100 mcg SA Request
329.5 KB

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Breo Ellipta 200 mcg SA Request
330.1 KB

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Formulaire d'inscription, d'ordonnace et de consentement destiné au patient (Francais) - Inflectra/Infliximar
956.6 KB

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Formulaire d’inscription et de consentement au programme XPOSE (Francais)
Pour les patients ayant reçu une ordonnance de COSENTYX pour le traitement du psoriasis en plaques modéré ou grave
1.5 MB

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Formulaire d’inscription et de consentement au programme XPOSE (Francais)
Pour les patients ayant reçu une ordonnance de COSENTYX (sécukinumab) pour le traitement du rhumatisme psoriasique ou de la spondylarthrite ankylosante
2.1 MB

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Find Objects - 2014 User Conference Pack
13.0 KB

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Incruse Ellipta 62.5 mcg SA Request
391.8 KB

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Innomar - Metoject - Rheumatoid Arthritis
223.8 KB

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Kintec Prescription Pad
1.4 MB

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Medical Marijuana (Cannabis) - MedReleaf
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(Ontario) Request for an Unlisted Drug Product - Toujeo
381.9 KB

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(Ontario) Demande de produit médicamenteux ne figurant pas dans la lister - Toujeo
632.0 KB

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Patient Enrolment, Rx and Consent Form (English) - Inflectra/Infliximar
838.1 KB

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Program enrollment and consent form - XPOSE (English)
For patients prescribed COSENTYX® (secukinumab) for moderate to severe plaque psoriasis
1.4 MB

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Program enrollment and consent form - XPOSE (English)
For patients prescribed COSENTYX® (secukinumab) for psoriatic arthritis or ankylosing spondylitis
1.5 MB

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Prolia (Denosumab) / Aclasta (Zolendronic Acid) - Osteoporosis - Alberta Blue Cross Special Authorization Request
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Prolia (Denosumab) - Osteoporosis - BC Pharmacare Special Authority Request
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Renflexis (Infliximab) - IBD, Arthritis, Psoriasis - Patient Support Program

Submitted by AccelEMR

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Special Authority Request - Insulin Glargine and Insulin Detemir
170.7 KB

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Special Authority Request - Toujeo
398.7 KB

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Taltz (Ixekizumab) - Plaque Psoriasis, Psoriatic Arthritis - Patient Support Program
Submitted by AccelEMR

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Taltz (Ixekizumab) - Plaque Psoriasis, Psoriatic Arthritis - Patient Support Program (French)
Submitted by AccelEMR

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Trelegy Ellipta - COPD - Patient Support Program
Submitted by AccelEMR - Updated Aug 2019

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Xtandi (Enzalutamide) - Prostate Cancer - Patient Assistance Program Enrollment
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Support: 1-800-708-6442 - Email: support@intrahealth.com