Drug Authorization Forms

GSC
GSC
MÉDIC Construction (CCQ)
  • A Drug Special Authorization form is required when a pharmacy receives a denial for an electronic drug claim that requires prior authorization. The pharmacy will receive a message indicating that the drug must be authorized. The pharmacy can then print the appropriate form(s) that corresponds to the special authorization drug. This form must be given to the plan member to be completed by their physician and returned to Green Shield Canada for assessment. The forms in this section of the website are for download and print only. If you require an accessible format, please click here or contact support@providerConnect.ca.
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  • A Drug Special Authorization form is required when a pharmacy receives a denial for an electronic drug claim that requires prior authorization. The pharmacy will receive a message indicating that the drug must be authorized. The pharmacy can then print the appropriate form(s) that corresponds to the special authorization drug. This form must be given to the plan member to be completed by their physician and returned to MÉDIC Construction (CCQ) for assessment. The forms in this section of the website are for download and print only. If you require an accessible format, please click here or contact support@providerConnect.ca.
  •  
  •  
  •    
  •  
  • - Or Search by alphabetic listing -
  •  
  •  




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