UBACARE
has built prescriber requisition forms that are easy for you to access and download
using your tablet, laptop and even mobile device to give you flexibility while you are
on the move. Save time using our add-on prescriber order forms which are
organized by medical therapy and/or drug name in the list below.
using your tablet, laptop and even mobile device to give you flexibility while you are
on the move. Save time using our add-on prescriber order forms which are
organized by medical therapy and/or drug name in the list below.
We are committed to providing extraordinary care for your patients.
If your therapy is not listed below, please consider electronically prescribing the medication
to us. Prescriptions must be sent from licensed prescribers and in accordance with your
Province/Territory prescribing laws.
Home Infusion Pharmacy Prescriber Order Form
Omadacycline (Nuzyra®) Prescriber Order Form
Ibalizumab-Uiyk (Trogarzo®) Prescriber Order Form
Vedolizumab (Entyvio®) Prescriber Order Form
Ustekinumab (Stelara®) Prescriber Order Form
Rituximab Prescriber Order Form
Infliximab Prescriber Order Form
Home Infusion Pharmacy Prescriber Order Form
Golimumab (Simponi Aria®) Prescriber Order Form
Certolizumab (Cimzia®) Prescriber Order Form
Abatacept (Orencia®) Prescriber Order Form
Immune Globulin – Transplant (Pediatrics) Prescriber Order Form (Peds)
Immune Globulin – Transplant (Pediatrics) Prescriber Order Form (Adult)
Immune Globulin (Pediatrics) Prescriber Order Form
Immune Globulin Maternal Fetal Medicine Prescriber Order Form
Immune Globulin (Adult) Prescriber Order Form
Ocrelizumab (Ocrevus®) Prescriber Order Form
Natalizumab (Tysabri®) Prescriber Order Form
Home Infusion Pharmacy Prescriber Order Form
Golodirsen (Vyondys 53®) Prescriber Order Form
Eteplirsen (Exondys 51®) Prescriber Order Form
Edaravone (Radicava®) Prescriber Order Form
Eculizumab (Soliris®) Prescriber Order Form
Ravulizumab (Ultomiristm) Prescriber Order Form
Pegloticase (Krystexxa®) Prescriber Order Form
Icatibant Prescriber Order Form
Home Infusion Pharmacy Prescriber Order Form
Ecallantide (Kalbitor®) Prescriber Order Form
C1 Esterase Inhibitor [Human] (Cinryze®) Prescriber Order Form
C1 Esterase Inhibitor [Human] (Berinert®) Prescriber Order Form
- Choosing a selection results in a full page refresh.
- Press the space key then arrow keys to make a selection.