Guidance for completing the Specify Brand Advice application form
1. Download the blank application form spreadsheet and save it in a convenient place
2. Open the blank form and save it with a new name which reflects the application under preparation. This will help you and the evaluator to identify the file
Practice and contact person details
3. Complete the application date, applicant practice and contact person details by typing them into the spreadsheet cells provided:
4. Select the appropriate practitioner role from the choices provided in the dropdown list (1):
Medicines covered by the application
5. Fill in the details of the medicine you want to be considered for Specify Brand Advice status. Always record the generic medicine name (1)Record the brand name of the medicine if you think it is relevant. This is optional If you think only some presentations of the medicine need Specify Brand Advice please specify them in the space provided (2)
Justification for Specify Brand Advice Status
6. Explain which guideline criterion you conclude related to the medicine by selecting the appropriate option from the dropdown box list (1).I f you are applying for more than 1 medicine to be given Specify brand Advice Status please make sure the criterion selected for medicine 1 relates to the medicine you nominated as medicine 1 in stop 5 above.
7. Provide any supporting comments (2) you think the evaluator will find helpful when considering your application.
8. Save the file and e—mail it to [email protected]
The NZULM and NZMT are services of the New Zealand Ministry of Health.