Brochures and Forms


HIV YourLife Programme:

 

HIV YourLife Programme member booklet

HIV YourLife Programme brochure

HIV YourLife Programme application form

HIV pre-exposure prophylaxis (PREP) application form

HIV post-exposure prophylaxis (PEP) application form

HIV Counselling and Testing (HCT) consent form

 

Hospital Risk Management:

 

Hospital Risk Management Brochure

Wound care authorisation form

 

Medicine Risk Management:

 

Medicine Risk Management Reference Guide

 

Pre-authorisation forms for biopharmaceuticals used in arthritic conditions:

Ankylosing Spondylitis: Initial Form

Ankylosing Spondylitis: Follow up Form

Juvenile Idiopathic Arthritis: Initial Form

Juvenile Idiopathic Arthritis: Follow up Form

Psoriatic Arthritis: Initial Form

Psoriatic Arthritis: Follow up Form

Rheumatoid Arthritis: Initial Form

Rheumatoid Arthritis: Follow up Form

 

Disease Risk Management

 

Disease Risk Management Brochure - Provider

Disease Risk Management Brochure - Member

 

Manufacturer Drug Application Forms

 

All pharmaceutical benefit management services have been outsourced to a third party, Mediscor.

 

Please direct all applications for: 

  • new medication
  • new medication indications
  • medication appeals 

to the Mediscor Pharmacy and Therapeutics Committee at mediscorptc@mediscor.co.za. 

 

Maternity Programme:

 

Maternity Programme Brochure - Provider

Maternity Programme Brochure - Member

 

Oncology Risk Management

 

Oncology Risk Management Brochure - Provider

Oncology Risk Management Brochure - Member

 

SAOC Authorisation Form