Autofill Ontario Eap Fragmin Request
Request Fragmin through the EAP — fill the patient section fast
An EAP request for Fragmin (Dalteparin Sodium) has a patient section and a physician section. This guide is an example of letting hivi fill the patient part quickly.
Official form and source
Start from the official source and always use the current version — form numbers and links can change:
- Service page: Get coverage for prescription drugs — ontario.ca
- Form (Central Forms Repository): EAP Request Fragmin (Dalteparin Sodium) Therapy — 014-4941-87
What this form is about
The EAP request for Fragmin asks the Exceptional Access Program to approve drug benefit coverage when the clinical criteria are met. The patient section identifies the individual; the physician provides the clinical justification.
Before you start: what to gather (patient section)
- The patient's name and Ontario health number.
- The prescribing physician to complete the clinical section.
How hivi makes it faster
- Store the patient details once. Save the name and health number in hivi.
- Autofill the patient section. Use the hivi Chrome extension on a web form, or fill a PDF from the saved profile inside hivi.
- Physician completes the clinical section.
- Submit to the EAP.
Why do it in hivi
The same patient details appear on every EAP form — for Fragmin, Lovenox, Innohep, and other EAP drugs. Stored once in hivi — in Canada, with self-hosted AI — the patient section fills itself each time.