ÎN ATENŢIA MEDICILOR PRESCRIPTORI ÎN CONTRACT CU CAS ARAD

Transmiterea formularelor specifice de verificare a respectării criteriilor de eligibilitate

aferente protocoalelor terapeutice (conform Ordinul nr. 141/2017) se va face la adresa de  email :   msef_casar@yahoo.com sau la numar de fax 0257 270207.-Formularele specifice sunt prezentate atat in format pdf cat si format docx

 

 

 

 

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1) formular specific A001E - ORLISTATUM.pdf 2) formular specific A008E - IMIGLUCERASUM.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 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 1) formular specific A001E - ORLISTATUM.docx 2) formular specific A008E - IMIGLUCERASUM.docx 3) formular specific B02BX04 - ROMIPLOSTINUM.docx 4) formular specific H005E - ACROMEGALIE.docx 5) formular specific H006C - TUMORI NEURO.docx 6) formular specific L004C.1 - BEVACIZUMABUM-mamar.docx 7) formular specific L004C.2 - BEVACIZUMABUM-colorectal.docx 8) formular specific L004C.3 - BEVACIZUMABUM-renal.docx 9) formular specific L004C.4 - BEVACIZUMABUM-pulmonar.docx 10) formular specific L008C.1 - IMATINIBUM-hematologie.docx 11) formular specific L008C.2 - IMATINIBUM-DFB.docx 12) formular specific L008C.3 - IMATINIBUM-GIST.docx 13) formular specific L012C - BORTEZOMIBUM.docx 14) formular specific L014C - RITUXIMABUM.docx 15) formular specific L01BB06 - CLOFARABINUM.docx 16) formular specific L01BB07 - NELARABINUM.docx 17) formular specific L01BC07 - AZACITIDINUM.docx 18) formular specific L01BC08 - DECITABINUM.docx 19) formular specific L01CX01.1 - TRABECTEDINUM-ovar.docx 20) formular specific L01CX01.2 - TRABECTEDINUM-sarcom.docx 21) formular specific L01XC08 - PANITUMUMABUM.docx 22) formular specific L01XC10 - OFATUMUMAB.docx 23) formular specific L01XC12 - BRENTUXIMAB VEDOTIN.docx 24) formular specific L01XE06 - DASATINIBUM.docx 25) formular specific L01XE07 - LAPATINIBUM.docx 26) formular specific L01XE08 - NILOTINIBUM.docx 27) formular specific L01XE10 - EVEROLIMUS (VOTUBIA).docx 28) formular specific L01XE10A - EVEROLIMUS (AFINITOR).docx 29) formular specific L01XE11.1 - PAZOPANIBUM-renal.docx 30) formular specific L01XE11.2 - PAZOPANIBUM-sarcom.docx 31) formular specific L01XE13 - AFATINIBUM.docx 32) formular specific L01XE14 - BOSUTINIBUM.docx 33) formular specific L01XE16 - CRIZOTINIBUM.docx 34) formular specific L01XE17 - AXITINIBUM.docx 35) formular specific L01XE18 - RUXOLITINIBUM.docx 36) formular specific L01XE23 - DABRAFENIBUM.docx 37) formular specific L01XE27 - IBRUTINIBUM.docx 38) formular specific L01XX44 - AFLIBERCEPTUM.docx 39) formular specific L01XX46 - OLAPARIBUM.docx 40) formular specific L026C.1 - TRASTUZUMABUM-adjuv.docx 41) formular specific L026C.2 - TRASTUZUMABUM-neoadjv.docx 42) formular specific L02BX03.1 - ABIRATERONUM-postch.docx 43) formular specific L02BX03.2 - ABIRATERONUM-prech.docx 44) formular specific L031C.1 - ERLOTINIBUM-pancreas.docx 45) formular specific L031C.2 - ERLOTINIBUM-pulmon.docx 46) formular specific L033C - TRASTUZUMABUM-metastatic.docx 47) formular specific L037C.1 - CETUXIMABUM-cap,gat.docx 48) formular specific L037C.2 - CETUXIMABUM-colorectal.docx 49) formular specific L038C.1 - SORAFENIBUM-HCC.docx 50) formular specific L038C.2 - SORAFENIBUM-renal.docx 51) formular specific L038C.3 - SORAFENIBUM-tiroidian.docx 52) formular specific L039M - AIJ.docx 53) formular specific L040M - AP.docx 54) formular specific L041M - SPONDILITA.docx 55) formular specific L042C.1 - SUNITINIBUM-renal.docx 56) formular specific L042C.2 - SUNITINIBUM-GIST.docx 57) formular specific L043M - POLIARTRITA.docx 58) formular specific L044L - PSORIAZIS.docx 59) formular specific L047C.1 - PEMETREXEDUM-mezotel.docx 60) formular specific L047C.2 - PEMETREXEDUM-pulmonar.docx 61) formular specific L04AX02 - TALIDOMIDUM.docx 62) formular specific B02BX05 - ELTROMBOPAG.docx 63) formular specific L01XC15- OBINUTUZUMAB.docx 64) formular specific L01XE24 - PONATINIBUM.docx Completare Formulare specifice -Ordin 310_27.04.2017.pdf Completare Formulare specifice- Ordin 406_ 31.05.2017.pdf