Life Saving Drugs Program – Change of treating physician form
We are working to improve this form, which currently does not display correctly in all web browsers. In the meantime:
- save the PDF to your hard drive
- open it with your PDF software
- type into the fields before printing, signing and returning to us.
We aim to provide documents in an accessible format. If you're having problems using a document with your accessibility tools, please contact us for help.
This form is for the new treating physician to complete when:
- a patient receiving LSDP medicine transfers into their care
- there are no changes to the patient’s treatment or eligibility information.
The patient (or their parent or guardian) must also sign the form to provide consent to us to collect personal information.