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 0258834339 sau 0258834514, cu confirmare de primire si va prescrie tratamentul

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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) formular specific A008E - IMIGLUCERASUM.pdf 3) Formular specific B02BX04 - ROMIPLOSTIMUM.pdf 2_4 formular specific H005E ACROMEGALIE.pdf 5) 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 10) Formular specific L008C1 - 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 L01CX011 - TRABECTEDINUM-ovar.pdf 20) Formular specific L01CX012 - TRABECTEDINUM-sarcom.pdf 21) formular specific L01XC08 - PANITUMUMABUM.pdf 3_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 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 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 L02BX032 - ABIRATERONUM-prech.pdf 44) Formular specific L031C1 - ERLOTINIBUM-pancreas.pdf 45) Formular specific L031C2 - ERLOTINIBUM-pulmon.pdf 46) formular specific L033C - TRASTUZUMABUM-metastatic.pdf 47) Formular specific L037C1 - CETUXIMABUM-capgat.pdf 48) Formular specific L037C2 - CETUXIMABUM-colorectal.pdf 49) Formular specific L038C1 - SORAFENIBUM-HCC.pdf 50) Formular specific L038C2 - SORAFENIBUM-renal.pdf 51) Formular specific L038C3 - SORAFENIBUM-tiroidian.pdf 52) formular specific L039M - AIJ.pdf 53) formular specific L040M - AP (22.03.17).pdf 54) formular specific L041M - SPONDILITA (22.03.17).pdf 55) formular specific L042C.1 - SUNITINIBUM-renal.pdf 56) formular specific L042C.2 - SUNITINIBUM-GIST.pdf 57) formular specific L043M - POLIARTRITA (22.03.17).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 66) formular specific A16AX07S.2 - SAPROPTERINUM non-PKU prin deficit de BH4.pdf 67) formular specific J05AX65 - G7.1 - harvoni.pdf 68) formular specific J05AX65 - G7.2 - harvoni.pdf 69) formular specific J05AX65 - G4 - harvoni.pdf 70) formular specific J05AX66.1 - viek+exviera.pdf 71) formular specific J05AX66.2 - viek + exviera.pdf 4_72 formular specific L01XC17 NIVOLUMAB.pdf 73) formular specific L01XE23-25 - DABRAFENIBUM + TRAMETINIBUM.pdf 74) formular specific L01XE15 - VEMURAFENIBUM.pdf 75) formular specific L02BB04.1 - ENZALUTAMIDUM - post chimioterapie.pdf 76) formular specific L02BB04.2 - ENZALUTAMIDUM - prechimioterapie.pdf 5_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 6_83 formular specific L01XE35 OSIMERTINIB.pdf 7_84 formular specific L01XC17NSCLC NIVOLUMAB pulmonar.pdf 8_85 formular specific L01XC17RCC NIVOLUMAB renal.pdf 9_86 formular specific L01XX45 CARFILZOMIBUM.pdf 10_87 formular specific L033CCG TRASTUZUMABUM gastric.pdf