Report the Unavailability of Hematology Medicines to EHA today!

Thank you. By reporting the unavailability of hematology medicine you are strengthening our efforts to improve patients' access to medicine across Europe.

You can fill out this form in less than 5 minutes. Using the comments boxes is optional. You can use them to provide any additional information that you would like to share with us.

If there is more than one drug unavailable to you or your patients, please fill out a separate form per unavailable drug

* 1. What is your connection to hematology medicines?

* 2. Where are you located?

* 3. What hematology medicine is currently unavailable?

* 4. The unavailability of this hematology medicine is…

* 5. Please indicate below the (approximate) start-, and (expected) end date of the unavailability.
(If unknown, leave open)

Start:
/
/
End:
/
/

* 6. The unavailability of this hematology medicine is...

* 7. Is an alternative treatment available?

T