Other exceptional circumstances forms
A handful of medicines and devices require a different form.
Download the relevant exceptional circumstances form
Bevacizumab alternative brand allowance form [DOCX, 82 KB]
Bevacizumab alternative brand allowance form [PDF, 112 KB]
Diabetes technology alternative brand allowance application form [PDF, 138 KB]
Imiglucerase (Cerezyme) renewal form for people with Gaucher disease [PDF, 116 KB]
Multiple sclerosis MS application for grandparented patients [PDF, 105 KB]
Paediatric oncology/haematology notification form: Existing medicine and/or indication [DOCX, 23 KB]
Paediatric oncology/haematology notification form: New medicine and/or indication form [DOCX, 28 KB]
Prednisolone oral liquid funding application [PDF, 235 KB]
Trastuzumab (Herceptin) Exceptional Circumstances form [PDF, 111 KB]