Pana la data implementarii modalitatii de transmitere a cererii online in platforma informatica din asigurarile de sanatate pentru inregistrarea Formularului specific sau, in situatia producerii unor intreruperi in functionarea PIAS, constatate si communicate de CNAS, ce nu permit medicului curant transmiterea online a cererii, prevazuta la art. 1 si art 3, acesta va transmite Casei de Asigurari de Sanatate Alba Formularul specific medicamentului, completat, semnat si parafat, fie in format electronic pe adresa de email comisii@casalba.ro, fie pe fax la numerele 0358105030 sau 0258834514, cu confirmare de primire si va prescrie tratamentul

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Formulare specifice-Ordin nr. 1407_2018 .pdf Formulare specifice Ordin 1229_2018.pdf Formulare specifice-Ordin 1158_2018.pdf Formulare specifice_Ordin 1139_2018.pdf Formulare specifice –Ordin 301_2018.pdf Formulare specifice –Ordin 1229_2017.pdf 1_Ordin 1187_2017.pdf Formulare specifice- Ordin nr. 820 _ 25 07 2017.pdf Formulare specifice- Ordin 406_ 31.05.2017.pdf 1) formular specific A001E - ORLISTATUM.pdf 2_2 anexa 1 formular A008E IMIGLUCERASUM.pdf 3) Formular specific B02BX04 - ROMIPLOSTIMUM.pdf 3_4 anexa 2 formular specific H005E ACROMEGALIE.pdf 4_5 anexa 3 formular specific H006C TUMORI NEURO.pdf 6) Formular specific L004C1 - BEVACIZUMABUM-mamar.pdf 7) Formular specific L004C2 - BEVACIZUMABUM-colorecta.pdf 8) Formular specific L004C3 - BEVACIZUMABUM-renal.pdf 9) Formular specific L004C4 - BEVACIZUMABUM-pulmonar.pdf 5_10 anexa 4 formular L008C1 IMATINIBUM.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 L01CX011 - TRABECTEDINUM-ovar.pdf 20) Formular specific L01CX012 - TRABECTEDINUM-sarcom.pdf 6_21 anexa 5 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 linia I Ord. 301_2018.pdf 26) formular specific L01XE08 - NILOTINIBUM.pdf 27) formular specific L01XE10 - EVEROLIMUS (VOTUBIA).pdf 28) formular specific L01XE10A - EVEROLIMUS (AFINITOR).pdf 29) Formular specific L01XE111 - PAZOPANIBUM-renal.pdf 30) Formular specific L01XE112 - 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 2_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 L02BX031 ABIRATERONUMpostch.pdf 43. formular specific L02BX032 ABIRATERONUMprech.pdf 44) Formular specific L031C1 - ERLOTINIBUM-pancreas.pdf 45) Formular specific L031C2 - ERLOTINIBUM-pulmon.pdf 46) formular specific L033C - TRASTUZUMABUM-metastatic.pdf 7_47 anexa 6 formular specific L037C1 CETUXIMABUMcapgat.pdf 8_48 anexa 7 formular specific L037C2 CETUXIMABUMcolorectal.pdf 9_49 anexa 8 formular specific L038C1 SORAFENIBUMHCC.pdf 10_50 anexa 9 formular specific L038C2 SORAFENIBUMrenal.pdf 11_51 anexa 10 formular specific L038C3 SORAFENIBUMtiroidian.pdf 12_52 anexa 11 formular specific L039M AIJ.pdf 13_53 anexa 12 formular specific L040M AP.pdf 14_54 anexa13 formular specific L041M SPONDILITA.pdf 15_55 anexa 14 formular specific L042C1 SUNITINIBUMrenal.pdf 16_56 anexa 15 formular specific L042C2 SUNITINIBUMGIST.pdf 17_57anexa 16 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 65) formular specific A16AX07S.1 - SAPROPTERINUM - fenilcetonurie.pdf 3_67) formular specific J05AX65 G71 harvoni.pdf 4_68) formular specific J05AX65 G72 harvoni.pdf 66) formular specific A16AX07S.2 - SAPROPTERINUM non-PKU prin deficit de BH4.pdf 69) formular specific J05AX65 - G4 - harvoni.pdf 70) formular specific J05AX66.1 - viek+exviera.pdf 71) formular specific J05AX66.2 - viek + exviera.pdf 72. formular specific L01XC17 NIVOLUMAB.pdf 73) formular specific L01XE23-25 - DABRAFENIBUM + TRAMETINIBUM.pdf 74) formular specific L01XE15 - VEMURAFENIBUM.pdf 75 formular specific L02BB041 ENZALUTAMIDUM post chimioterapie.pdf 76 formular specific L02BB042 ENZALUTAMIDUM prechimioterapie.pdf 77 formular specific L01XE02 GEFITINIBUM.pdf 78) formular specific A16AB10 - VELAGLUCERASE ALFA.pdf 79) formular specific L002G - scleroza multipla.pdf 80) formular specific M09AX03 - ATALUREN.pdf 81) formular specific B06AC02 - ICATIBANTUM.pdf 82) formular specific L01XC14 - TRASTUZUMABUM EMTASINUM.pdf 83 formular specific L01XE35 OSIMERTINIB.pdf 84 formular specific L01XC17NSCLC NIVOLUMAB pulmonar.pdf 85 formular specific L01XC17RCC NIVOLUMAB renal.pdf 86 formular specific L01XX45 CARFILZOMIBUM.pdf 87 formular specific L033CCG TRASTUZUMABUM gastric.pdf 88 formular specific N06BX13 IDEBENONUM.pdf 89 formular specific L034K.pdf 90 formular specific L01XE07 II LAPATINIBUM cu capecitabina.pdf 91) formular specific L01XC19 BLINATUMOMABUM.pdf 92) formular specific L01XC24 DARATUMUMAB.pdf 93) formular specific L01XX42 PANOBINOSTAT.pdf 94) formular specific L01XX52 VENETOCLAX.pdf 18_95 anexa 19 formular specific M09AX07 NUSINERSEN.pdf 96) formular specific L01AA09 Bendamustinum.pdf 19_97 anexa 20 formular specific A16AX10 ELIGLUSTAT.pdf 98) formular specific H01AC03 Mecaserminum.pdf 99) FORMULAR L01XC18.1 - PEMBROLIZUMABUM - Neoplasm bronhopulmonar altul decat cel cu celule mici.pdf 100) FORMULAR L01XC18.2 - PEMBROLIZUMABUM - Melanom malign.pdf 101) FORMULAR L01XE33 - PALBOCICLIBUM - neoplasm mamar.pdf 102) FORMULAR L01XC21 - RAMUCIRUMABUM - neoplasm gastric.pdf 103) FORMULAR L01XC11 - IPILIMUMABUM - melanom malign avansat si metastatic.pdf 104) FORMULAR L01XC13 - PERTUZUMABUM - Neoplasm mamar avansat in asociere cu Transtuzumab si Taxani.pdf 105) FORMULAR L01XC27 - OLARATUMAB - Sarcom de tasuturi moi avansat.pdf 106) FORMULAR L004C.5 - BEVACIZUMABUM - Neoplasm ovarian epitelial, trompe uterine sau peritoneal pr.pdf 107) Formular specific J05AX61 F1F4.pdf 108) Formular specific J05AX62 IRC.pdf 109) Formular specific J05AX63 postransplant hepatic.pdf 20_110 anexa 21 formular specific L01CD04 CABAZITAXEL.pdf 21_111 anexa 22 formular specific L04AA26 BELIMUMABUM.pdf