PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form HLTH5470
for the current year.
Form HLTH5470 Special Authority Request - Filgrastim (Grastofil Type) - British Columbia, Canada
Form HLTH5470 Special Authority Request - Filgrastim (Grastofil Type) in British Columbia, Canada is used to request special authority coverage for the medication Filgrastim, specifically the Grastofil Type. This form allows patients to apply for coverage for this medication from the provincial health authority.
The form HLTH5470 Special Authority Request for Filgrastim (Grastofil Type) in British Columbia, Canada is typically filed by the prescribing healthcare provider or their designated representative.
FAQ
Q: What is the purpose of this form?A: This form is used to request special authority for Filgrastim (Grastofil Type) in British Columbia, Canada.
Q: What is Filgrastim?A: Filgrastim is a medication used to stimulate the production of white blood cells in the body.
Q: What is special authority?A: Special authority is a process by which coverage for certain medications is considered on a case-by-case basis.
Q: Who can use this form?A: This form can be used by healthcare professionals in British Columbia, Canada to request special authority for their patients.
Q: What is Grastofil?A: Grastofil is a type of Filgrastim medication.
Q: What information is required on this form?A: The form requires information about the patient, the healthcare professional, the medication being requested, and the reason for the request.
Q: What happens after the form is submitted?A: The form will be reviewed by the Ministry of Health, and a decision will be communicated to the healthcare professional.
Q: Is there a fee for submitting this form?A: There is no fee for submitting this form.
