Pharmacy Services / Prior Approvals

Dear Pharmacy Service Providers,
Please be aware complete the missing details as in beneficiary card.
Please complete the data missing for English Only.
All attached downloads must be Original and Clear.
Sincerely!

Select Action Pharmacy*

Governorate*

Branch / Area*

Date Of Physician's Prescriptions*

Date Of Physician's Prescriptions

Date Of Dispensing Drugs*

Date Of Dispensing Drugs

Diagnostic*

Other Diagnostic

Items / Diabetes Drugs

Items / Hypertension Drugs

Items / Heart Diseases Drugs

Items / Kidney Drugs

Items / Osteoporosis Drugs

Items / Abdominal Pain Drugs

Items / Bronchitis Drugs

Items / Otic Diseases Drugs

Items / Gyna Diseases Drugs

Items / Hypotension Drugs

Items / Rhinitis Drugs

Items / Tinea Drugs

Items / Hemorrhoids Drugs

Items / Burns Drugs

Items / Glaucoma Drugs

Items / Thyroid Diseases Drugs

Items / Hepatitis Drugs

Items / Migraine Drugs

Items / Arthritis Drugs

Items / Common Cold Drugs

Items / Dermatitis Drugs

Items / Dental Drugs

Items / Neural Diseases Drugs

Items / Eye Diseases Drugs

Important! A) Here only add another medication not the same effect or replacement from listed above! B) If you haven't please put **Nil***

Value Of Prescriptions*

Endurance Ratios*

Beneficiary's Copayment*

Beneficiary's Card*

Beneficiary's National ID*

Physician Prescriptions*

Swagrass Form*

Beneficiary's Phone Number*

Attention, Very Important.

A) The doses of the drugs that are dispensed do not exceed the validity of the beneficiary's card.

B) The doses of the drugs that are dispensed do not exceed the number of days, and the number of doctor's prescriptions is the framework for the distribution of medicines...

A)The doses of drugs dispensed do not exceed the expiry time of the Beneficiary's card.

B)The doses of drugs dispensed do not exceed number of days, number and the Physician's Prescriptions Frame Of Dispensing Drugs...

Frame of Physician Prescriptions**

**QTY _ For Times _ For Days** Druga #1

**QTY _ For Times _ For Days** Druga #2

**QTY _ For Times _ For Days** Druga #3

**QTY _ For Times _ For Days** Druga #4

**QTY _ For Times _ For Days** Druga #5

**QTY _ For Times _ For Days** Druga #6

**QTY _ For Times _ For Days** Druga #7

**QTY _ For Times _ For Days** Druga #8

**QTY _ For Times _ For Days** Druga #9

**QTY _ For Times _ For Days** Druga #10

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