Formulare specifice - pentru verificarea respectării criteriilor de eligibilitate aferente protocoalelor terapeutice pentru medicamentele notate cu (**)1 , (**)1Ω şi (**)1β, formulare aprobate prin Ordinul CNAS nr 141/2017

-- > Vizualizare ORDIN nr.141 din 28.02.2017

 

FORMULARELE SPECIFICE SE TRANSMIT DE MEDICII PRESCRIPTORI PE EMAIL LA CASA JUDETEANA DE ASIGURARI DE SANATATE HUNEDOARA PANA LA DATA IMPLEMENTARII MODALITATII DE TRANSMITERE A CERERII ONLINE, PRECUM SI IN SITUATIA PRODUCERII UNOR INTRERUPERI IN FUNCTIONAREA PIAS. CERERILE VOR FI INREGISTRATE DE CAS INTR-UN REGISTRU CONSTITUIT CU ACEASTA DESTINATIE SI VOR FI PROCESATE IN SIUI DE LA DATA LA CARE MODULUL VA DEVENI FUNCTIONAL.

PRECIZAM FAPTUL CA, PENTRU ACESTE SITUATII MEDICII PRESCRIU TRATAMENTUL DUPA TRANSMITEREA FORMULARULUI SPECIFIC LA CAS, FARA A FI NECESARA O CONFIRMARE A INREGISTRARII PRIMIRII FORMULARULUI SPECIFIC LA CAS.

fax: 0254/218911

e-mail: pns@cjashd.ro

 

--> Descarcati de aici toate formularele arhivate.

 

Descarcati de mai jos formularele (aranjate in pagina) in format PDF :

 

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1- formular specific A001E - ORLISTATUM.pdf 2- formular specific A008E - IMIGLUCERASUM.pdf.pdf 3- formular specific B02BX04 - ROMIPLOSTINUM.pdf 4- formular specific H005E - ACROMEGALIE.pdf 5- formular specific H006C - TUMORI NEURO.pdf 6- formular specific L004C.1 - BEVACIZUMABUM-mamar.pdf 7- formular specific L004C.2 - BEVACIZUMABUM-colorectal.pdf 8- formular specific L004C.3 - BEVACIZUMABUM-renal.pdf 9- formular specific L004C.4 - BEVACIZUMABUM-pulmonar.pdf 10- formular specific L008C.1 - IMATINIBUM-hematologie.pdf 11- formular specific L008C.2 - IMATINIBUM-DFB.pdf 12- formular specific L008C.3 - IMATINIBUM-GIST.pdf 13- formular specific L012C - BORTEZOMIBUM.pdf 14- formular specific L014C - RITUXIMABUM.pdf 15- formular specific L01BB06 - CLOFARABINUM.pdf 16- formular specific L01BB07 - NELARABINUM.pdf 17- formular specific L01BC07 - AZACITIDINUM.pdf 18- formular specific L01BC08 - DECITABINUM.pdf 19- formular specific L01CX01.1 - TRABECTEDINUM-ovar.pdf 20- formular specific L01CX01.2 - TRABECTEDINUM-sarcom.pdf 21- formular specific L01XC08 - PANITUMUMABUM.pdf 22- formular specific L01XC10 - OFATUMUMAB.pdf 23- formular specific L01XC12 - BRENTUXIMAB VEDOTIN.pdf 24- formular specific L01XE06 - DASATINIBUM.pdf 25- formular specific L01XE07 - LAPATINIBUM.pdf 26- formular specific L01XE08 - NILOTINIBUM.pdf 27- formular specific L01XE10 - EVEROLIMUS _VOTUBIA_.pdf 28- formular specific L01XE10A - EVEROLIMUS (AFINITOR).pdf 29- formular specific L01XE11.1 - PAZOPANIBUM-renal.pdf 30- formular specific L01XE11.2 - PAZOPANIBUM-sarcom.pdf 31- formular specific L01XE13 - AFATINIBUM.pdf 32- formular specific L01XE14 - BOSUTINIBUM.pdf 33- formular specific L01XE16 - CRIZOTINIBUM.pdf 34- formular specific L01XE17 - AXITINIBUM.pdf 35- formular specific L01XE18 - RUXOLITINIBUM.pdf 36- formular specific L01XE23 - DABRAFENIBUM.pdf 37- formular specific L01XE27 - IBRUTINIBUM.pdf 38- formular specific L01XX44 - AFLIBERCEPTUM.pdf 39- formular specific L01XX46 - OLAPARIBUM.pdf 40- formular specific L026C.1 - TRASTUZUMABUM-adjuv.pdf 41- formular specific L026C.2 - TRASTUZUMABUM-neoadjv.pdf 42- formular specific L02BX03.1 - ABIRATERONUM-postch.pdf 43- formular specific L02BX03.2 - ABIRATERONUM-prech.pdf 44- formular specific L031C.1 - ERLOTINIBUM-pancreas.pdf 45- formular specific L031C.2 - ERLOTINIBUM-pulmon.pdf 46- formular specific L033C - TRASTUZUMABUM-metastatic.pdf 47- formular specific L037C.1 - CETUXIMABUM-cap,gat.pdf 48- formular specific L037C.2 - CETUXIMABUM-colorectal.pdf 49- formular specific L038C.1 - SORAFENIBUM-HCC.pdf 50- formular specific L038C.2 - SORAFENIBUM-renal.pdf 51- formular specific L038C.3 - SORAFENIBUM-tiroidian.pdf 52- formular specific L039M - AIJ.pdf 53- formular specific L040M - AP.pdf 54- formular specific L041M - SPONDILITA.pdf 55- formular specific L042C.1 - SUNITINIBUM-renal.pdf 56- formular specific L042C.2 - SUNITINIBUM-GIST.pdf 57- formular specific L043M - POLIARTRITA.pdf 58- formular specific L044L - PSORIAZIS.pdf 59- formular specific L047C.1 - PEMETREXEDUM-mezotel.pdf 60- formular specific L047C.2 - PEMETREXEDUM-pulmonar.pdf 61- formular specific L04AX02 - TALIDOMIDUM.pdf 62- formular specific B02BX05 - ELTROMBOPAG.pdf 63- formular specific L01XC15- OBINUTUZUMAB.pdf 64- formular specific L01XE24 - PONATINIBUM.pdf