Apply for Exceptional Access Program Aldurazyme® funding without retyping patient and prescriber details

Physicians and nurse practitioners requesting Ontario Drug Benefit funding for Aldurazyme® repeat patient name, health number, prescriber registration, and practice contact on every drug-specific EAP request. This guide is an example of storing them once in hivi.

Official form and source

Start from the official source and always use the current version — form numbers and links can change:

• Service page: Exceptional Access Program — ontario.ca
• Form (Central Forms Repository): Request for Aldurazyme® — 014-4846-87

What this form is about

Form 014-4846-87 is the Request for Aldurazyme® used under the Exceptional Access Program when an Ontario prescriber seeks ODB funding for laronidase (Aldurazyme®) for an eligible patient — confirm clinical criteria on ontario.ca.

Before you start: what to gather

• Patient full legal name and health number.
• Prescriber name, registration number, and practice contact.
• Diagnosis and clinical justification for Aldurazyme®.
• Prior therapies and supporting documentation — confirm on ontario.ca.

Confirm the current process on ontario.ca.

How hivi makes it faster

1. Save it once. Store your patient health number and prescriber contact details in your hivi profile.
2. Keep documents ready. Upload supporting documents to hivi Files so you are not searching at form time.
3. Autofill the form. Use the hivi Chrome extension on a web form, or fill a PDF from your saved profile inside hivi.
4. Review and submit yourself through the official channel.

Why do it in hivi

Related Ontario forms repeat the same personal details. Captured once in hivi — stored in Canada, with AI on its own servers — every form starts mostly complete.