|Classification / Identification:|
| ||Form Number:||014-4941-87E||Edition date: ||2017/06 |
| ||Title:||Exceptional Access Program (EAP) Request Fragmin (Dalteparin Sodium) Therapy|
| ||Ministry:||Health|| || |
| ||Branch/ABC:||Drug Programs Delivery Branch|| || |
| ||Program:||Drug Programs Delivery Branch|| || |
| ||Purpose of Form:||The purpose of the e-Form is to assist physicians in the EAP drug request process by integrating all the rules/criteria into an interactive e-Form that will ensure all the necessary information is captured.|| || |
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