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Life Saving Drugs Program – Change of treating physician form
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- save the PDF to your hard drive
- open it with your PDF software
- type into the fields before signing and returning to us.
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Publication date:
Date last updated:
Publication type:
Form
Language:
English
Description:
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.