EHA - Access to Medicine

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

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* 1. What is your connection to hematology medicines?

I am a hematologist/oncologist

I am a patient

I am a nurse

I am a patient advocate

I work in the industry

Other (please specify)

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* 2. Where are you located?

City/Town:

Country:

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* 3. What hematology medicine is currently unavailable?

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* 4. The unavailability of this hematology medicine is…

Long-term

Short-term

I don’t know

Comments

Question Title

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

Start:

Date

End:

Date

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

Unexpected

Expected

I don’t know

Comments

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* 7. Is an alternative treatment available?

Yes, there is an alternative treatment of equivalent efficacy available

Yes, there is an alternative treatment available, but this treatment is less efficacious (please use the comment box to provide further information on the consequences for patient care or therapeutic outcomes)

No (please use the comment box to provide further information on the consequences for patient care or therapeutic outcomes)

I don't know

Comments

Question Title

* 1. What is your connection to hematology medicines?

Question Title

* 2. Where are you located?

Question Title

* 3. What hematology medicine is currently unavailable?

Question Title

* 4. The unavailability of this hematology medicine is…

Question Title

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

Question Title

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

Question Title

* 7. Is an alternative treatment available?

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