Formularele specifice pentru verificarea respectării criteriilor de eligibilitate aferente protocoalelor terapeutice,  pentru medicamentele notate cu (**)1 , (**)1Ω si (**)1β  în Lista cuprinzând denumirile comune internaţionale corespunzătoare medicamentelor de care beneficiază asiguraţii, cu sau fără contribuţie personală, pe bază de prescripţie medicală, în sistemul de asigurări sociale de sănătate, precum şi denumirile comune internaţionale corespunzătoare medicamentelor care se acordă în cadrul programelor naţionale de sănătate, aprobată prin HG nr. 720/2008, cu modificările și completările ulterioare şi a metodologiei de transmitere a acestora in Platforma informatică din asigurările de sănătate

 

Formularele se transmit la :

                            fax nr. 02405107532

                 sau      email:  servmed@castl.ro

(pana la implementarea modalitatii de transmitere a cererii online in PIAS)

 

 

Note

- 16.11.2017 - prin Ord.CNAS nr.1187/2017 a fost completat Ord.CNAS nr.141/2017 cu un numar de 4 noi formulare specifice  (vezi ordinul)

- 28.07.2017 - prin Ord.CNAS nr.820/2017 a fost completat Ord.CNAS nr.141/2017 cu un numar de 3 noi formulare specifice  (vezi ordinul)

- 31.05.2017 - prin Ord.CNAS nr.406/2017 a fost completat Ord.CNAS nr.141/2017 cu un numar de 3 noi formulare specifice si au fost actualizate un numar de 38 de formulare specifice  (vezi informare)

- 08.05.2017 - s-au introdus in PIAS o serie de scheme terapeutice  (vezi informarea)

Fișiere atașate

Formular specific L038C.2 - SORAFENIBUM-renal - 31.05.2017.pdf Formular specific L038C.3 - SORAFENIBUM-tiroidian- 31.05.2017.pdf Formular specific M09AX03 - ATALUREN - 31.05.2017.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 Formular specific L01XE35 - OSIMERTINIB - 27.07.2017.pdf 40) formular specific L026C.1 - TRASTUZUMABUM-adjuv.docx Formular specific B06AC02 - ICATIBANTUM - 27.07.2017.pdf 41) formular specific L026C.2 - TRASTUZUMABUM-neoadjv.docx Formular specific L01XC14 - TRASTUZUMABUM EMTASINUM - 27.07.2017.pdf 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 55) formular specific L042C.1 - SUNITINIBUM-renal.docx 56) formular specific L042C.2 - SUNITINIBUM-GIST.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 Formular specific_H005E 08.11.2017.pdf Formular specific_L033C_CG 08.11.2017.pdf Formular specific_L01XX45 08.11.2017.pdf Formular specific_L01XC17-RCC 08.11.2017.pdf 77) formular specific L01XE02 - GEFITINIBUM.docx Formular specific_L01XC17_NSCLC 08.11.2017.pdf 53) formular specific L040M - AP (22.03.2017).docx Formular specific_L01XE35 08.11.2017.pdf 54) formular specific L041M - SPONDILITA (22.03.2017).docx Formular specific_L01XE02 08.11.2017.pdf 57) formular specific L043M - POLIARTRITA (22.03.2017).docx Formular specific_L01XC17 08.11.2017.pdf 65) formular specific A16AX07S.1 - SAPROPTERINUM fenilcetonurie.docx Formular specific_L01XC10 08.11.2017.pdf 65) formular specific A16AX07S.2 - SAPROPTERINUM - non PKU prin deficit de BH4.docx 67) formular specific J05AX65-G7.1 - COMBINATII (SOFOSBUVIR + LEDIPASVIR).docx 68)formular specific J05AX65 - G7.2 - COMBINATII (SOFOSBUVIR + LEDIPASVIR).docx 69) formular specific J05AX65 - G4 - COMBINATII (SOFOSBUVIR + LEDIPASVIR).docx 70) formular specific J05AX66.1 - COMBINATII (OMBITASVIR+PARITAPREVIR+RITONAVIR) +DCI DASABUVIR.docx 71) formular specific J05AX66.2 - COMBINATII (OMBITASVIR+PARITAPREVIR+RITONAVIR) +DCI DASABUVIR.docx 72) formular specific L01XC17 - NIVOLUMABUM.docx 73) formular specific L01XE23-25 - COMBINATII DCI DABRAFENIBUM+DCI TRAMETINIBUM.docx 74) formular specific L01XE15 - VEMURAFENIBUM.docx 75) formular specific L02BB04.1 - ENZALUTAMIDUM postchimioterapie.docx 76) formular specific L02BB04.2 - ENZALUTAMIDUM prechimioterapie.docx Formular specific A16AB10 - VELAGLUCERASE ALFA- 31.05.2017.pdf Formular specific B02BX04 - ROMIPLOSTIMUM - 31.05.2017.pdf Formular specific B02BX05 - TROMBOPAG - 31.05.2017.pdf Formular specific H005E - ACROMEGALIE SI GIGANTISM- 31.05.2017.pdf Formular specific L001BB06 - CLOFARABINUM - 31.05.2017.pdf Formular specific L001BB07 - NELARABINUM - 31.05.2017.pdf Formular specific L01BC07 - AZACITIDINUM - 31.05.2017.pdf Formular specific L01BC08 - DECITABINUM - 31.05.2017.pdf Formular specific L01CX01.1 - TRABECTEDINUM -ovar- 31.05.2017.pdf Formular specific L01CX01.1 - TRABECTEDINUM -sarcom- 31.05.2017.pdf Formular specific L01XC10 - OFATUMUMAB- 31.05.2017.pdf Formular specific L01XC12 - BRENTUXIMAB VEDOTIN- 31.05.2017.pdf Formular specific L01XC15 - OBINUTUZUMAB- 31.05.2017.pdf Formular specific L01XE02 - GEFITINIBUM- 31.05.2017.pdf Formular specific L01XE06 - DASATINIBUM- 31.05.2017.pdf Formular specific L01XE07 - LAPATINIBUM- 31.05.2017.pdf Formular specific L01XE08 - NILOTINIBUM- 31.05.2017.pdf Formular specific L01XE11.1 - PAZOPANIBUM-renal- 31.05.2017.pdf Formular specific L01XE11.2 - PAZOPANIBUM-sarcom- 31.05.2017.pdf Formular specific L01XE14 - BOSUTINIBUM- 31.05.2017.pdf Formular specific L01XE18 - RUXOLITINIBUM- 31.05.2017.pdf Formular specific L01XE24 - PONATINIBUM- 31.05.2017.pdf Formular specific L01XE27 - IBRUTINIBUM- 31.05.2017.pdf Formular specific L02BX03.2 - ABIRATERONUM-prech- 31.05.2017.pdf Formular specific L002G - SCLEROZA MULTIPLA - 31.05.2017.pdf Formular specific L04AX02 - TALIDOMIDUM - 31.05.2017.pdf Formular specific L004C.1 - BEVACIZUMABUM-mamar - 31.05.2017.pdf Formular specific L004C.2 - BEVACIZUMABUM-colorectal - 31.05.2017.pdf Formular specific L004C.3 - BEVACIZUMABUM-renal - 31.05.2017.pdf Formular specific L004C.4 - BEVACIZUMABUM-pulmonar - 31.05.2017.pdf Formular specific L008C.1 - IMATINIBUM-hematologie - 31.05.2017.pdf Formular specific L0012C - BORTEZOMIBUM - 31.05.2017.pdf Formular specific L0014C - RITUXIMABUM - 31.05.2017.pdf Formular specific L031C.1 - ERLOTINIBUM-pancreas- 31.05.2017.pdf Formular specific L031C.2 - ERLOTINIBUM-pulmon- 31.05.2017.pdf Formular specific L037C.2 - CETUXIMABUM-colorectal - 31.05.2017.pdf Formular specific L038C.1 - SORAFENIBUM-hcc - 31.05.2017.pdf