In order to allow the correct management of orders, avoiding blockages or delays to import and deliveries, the forms must be filled out reporting:

• Therapeutic indication registered in the country of origin

• If the request is for escort or for patients already identified

• In the case of patients already identified, the initials of surname and name, date of birth, pathology, dosage to be applied (The quantity of packages ordered is for a maximum duration of the 90-day therapy)

• Stamp of the Hospital or equivalent institution, on each form

For a correct readability, please do not overlap the stamp and signature