Life Saving Drugs Program – Late infantile Batten disease (CLN2 disease) – Reapplication
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- Saving the PDF to your hard drive and opening it with your PDF software. You can then type into the fields before printing, signing and returning to us.
- Downloading and printing the Word version. You can fill it out by hand, sign and return to us.
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This form includes:
- patient eligibility checklist
- privacy notice and patient consent
- dosing details
- treating physician’s declaration
- reapplication checklist.