Cover image of Fabry disease initial application form

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Life Saving Drugs Program – Fabry disease – Initial application

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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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Publication date: 
7 October 2020
Last updated: 
8 December 2021
Publication type: 
Form
Intended audience: 
Health sector
Description: 

This form includes:

  • information about the application process and timelines
  • treating physician’s responsibilities
  • privacy notice and patient consent
  • health professional details
  • dosing details
  • eligibility requirements and test results
  • treating physician’s declaration
  • application checklist.