- This form may be completed by either the prescriber or consultant ophthalmic professional. This form must be signed by the prescriber and faxed to SHARE for every patient at baseline (within 4 weeks of starting SABRIL).
- For patients formally exempted from visual assessment due to blindness or irreversible neurological condition, subsequent forms are not required to be submitted.
- For all other patients, follow-up assessment forms are required to be submitted at least every 90 days while the patient is taking SABRIL and approximately
3-6 months after discontinuation.
- The diagnostic approach should be individualized according to each patient and/or clinical situation. Although attempts should be made to assess visual acuity and visual fields, no specific tests are required.
- All fields must be completed.
Completed forms should be faxed to the SHARE Call Center at 1-877-742-1002.