All Special Authority eForms 2020

Updated 2022-Nov-10 13:30 updated SA_COPD form to latest 2022/10/17 version.

Updated 2021-Jun-19 08:23 Typo fixed.

Updated 2021-Jun-18 15:58 to include Rivaroxaban.

Updated 2021-Feb-19 16:26 3rd Line DM form changed between October and December of 2020. Generic form updated to version 29

Updated January 7th 2021 - new signature script added

Updated December 22th 2020 to accommodate the newest 3rd line DM med eFORM. With content update per HerbC. If a specific one is required, there should be link. Please do not rename, as the links will break. You will have to "delete" (archive) your existing SA generic eFORM to allow this one to zip in.

Updated Dec 17 2020 - new coverage of diabetic medication also requiring new generic form.

Update Jul2020 - another major upgrade needed due to introduction of TWO new eFORMS - for COPD inhalers and ARBs. Some drugs no longer SA - e.g. Plavix. If a drug requires a specific form, you will automatically be shifted to the correct form. If you wish to go back to the main (generic) form, there is a link at the top of each eFORM. For this to work properly, you will need ALL the forms updated. Gotta get them all!

For medication coverage in BC. All other Special Authority eForms are linked to the SA Generic eFORM. This replaces the old Special Authority 2015 eFORM and has been fully updated. A few names are updated, so they will not link with older versions. Most of the names are the same, so if an eFORM does not zip import, please delete/archive the older version with the same name and try again.

SA_Analogue_Insulin is a request to Pharmacare to provide a list of patients who have been prescribed Insulin Lispro (Humalog) or Aspart (NovoRapid).  These insulins will no longer be covered fully, unless switched to their biosimilar products Admelog or Trurapi.

SA_DM_V9_Jan13_2022 - bug fixed that resulted in side warning being printed.

SA_Generic_V33_Apr21_2022.zip - fix broken link to Formulary Search

New SA form for Dapagliflozin for use in HFrEF now available.  Note - this requires additional measurement of LVEF, which may not be available on your system.  It will be evident if the eFORM does not save and you get a red-highlighted pop-up indicating this.  SA_Dapagliflozin_HFrEF_V1_Aug23_2022.zip

Attached Files

FileAction
SA_COPD_V7_Nov8_2022.zip SA eFORM to access COPD inhalers. Replaces SA LAMA. Requires specific measurements - FEV1, FEVR. If you have the COPD advisor working, then those measurements are likely in place.Download
SA_Dapagliflozin_HFrEF_V1_Aug23_2022.zip. Requires LVEF measurement.Download
SA_Generic_V33_Apr21_2022.zip Fix broken link to Formulary SearchDownload
PlanG_V6_May24_2020.zip Fix signature function, such that discrete dot is added if signature field is left blank. Previously, none of the signatures saved unless ALL the fields were completed in some fashion.Download
Plan_P_V9_Jul7_2021.zip Fix signature function, such that discrete dot is added if signature field is left blank. Previously, none of the signatures saved unless ALL fields had input. Also cue to complete primary and secondary dx field. V9 has attention-seeking submit button and other 2021 upgrades. Download
SA_ARB_V1_Jul14_2020.zip New SA eFORM to access angiotensin receptor blocker (ARB) meds.Download
SA_Analogue_Insulin_Initiative_V1_Jan8_2022.zipDownload
SA_Basal_Insulin_V3_Jul14_2020.zip SA eFORM to access Basaglar.Download
SA_DM_V9_Jan13_2022.zipDownload
SA_PPI_V10_Jul14_2020.zip SA eFORM to access PPI meds.Download
SA_CI_V7_Jul14_2020.zip SA eFORM to access Donepezil. Also for renewals and CI switch. Requires MMSE measurement.Download
SA_DOAC_V10_Jul14_2020.zip SA eFORM to access direct oral anticoagulant (DOAC) drugs for stroke prevention in AF. To access DOAC for treatment of DVT/PTE, use the SA Generic eFORM.Download
SA_Ticagrelor_V3_Jul14_2020.zip SA eFORM to access Ticagrelor/Brilinta for complex CAD.Download
SA_LMWH_V6_Jul14_2020.zip SA eFORM to access injectable heparins for treatment and prevention of VTE. See SA VTE Cancer Pt for use of LMWH in cancer thrombosis.Download
SA_VTE_Cancer_Pt_V3_Jul14_2020.zip SA eFORM to access injectable heparins (LMWH) for cancer patients with VTE, or requiring VTE prevention, if Warfarin is contra-indicated. Not for CVA protection in AF.Download
SA_Filgrastim_V3_Jul14_2020.zip SA eFORM to access Filgrastim/Grastofil - for neutropenia.Download
SA_ADHD_V7_Nov16_2021.zip SA eFORM to access stimulant and non-stimulant meds for ADHD. — Updated on 2021-11-16Download
SA_Sovaldi_V3_Jul14_2020.zip SA eFORM to access Solvadi for HCV treatment, genotype 1, 2, or 3. Only available to gastroenterology and infectious disease.Download
SA_Harvoni_V3_Jul14_2020.zip SA eFORM to access Harvoni for HCV treatment, genotype 1 only. Only available to gastroenterology and infectious disease.Download
  • Version 
  • Last Updated  November 10, 2022
  • Downloads  2022