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How to Withdraw an Additional Form Request

Additional Forms may be used to submit other requests related to Enrolment in a Patient Support Program, such as free drug access. If the patient passes away, secures alternative funding, or discontinues therapy, they may be withdrawn from the program.

undefined-Jul-21-2023-06-20-17-8672-PM-2 NOTE Only users with the appropriate permissions will have the ability to Withdraw a patient from the Additional Form process. 

Withdrawing a Request 

When withdrawals are enabled, and you have the necessary permissions, the Withdrawn option is visible in the ice cream menu beside the Additional Form.  

The ice cream menu is displayed for an Additional Form on the Patient’s Profile with the option to withdraw, delete, mark as complete and send to archive.

After selecting Withdraw from the menu, you are prompted to choose the reason from a dropdown list and enter any Additional Notes.  

Withdraw dialog window with a dropdown menu to choose the reason along with an area to add additional notes.

After clicking OK, the Additional Notes are converted into a Comment and saved to the Form. 

undefined-Jul-21-2023-06-20-17-8672-PM-2 NOTE You can withdraw forms that are Active or Completed, but not those that are Archived. 

The withdrawn reason and comment is displayed on the bottom of the Additional Form.

Finding Withdrawn Requests 

Once a Form is Withdrawn it will be stored in the Withdrawn tab of the Patient’s Additional Forms section.

Withdrawn tab of the Patient’s Additional Forms section is displayed here.

Withdrawn requests are also found on the Status Table. Use the third filter dropdown to select the state of the Form. You can use this filter to view Withdrawn, Archived, Completed or Active Forms. 

Status table with dropdown filters to choose the state of a form.