A practitioner, for example on behalf of a hospital or clinic, uses Form B to request a drug not marketed in Canada ahead of an anticipated emergency, when the patient is not yet identified. Health Canada's examples include drugs that may need to be readily available in hospital emergency departments. The practitioner must give a valid reason for needing the drug in advance and later reports which patients received it.
The requesting practitioner completes the whole form, including shipping details, the clinical circumstances for future use and the signed attestation; the person receiving the shipment must be a practitioner or pharmacist.
Download the current version from the source each time; forms change without notice.
Special Access Program (drugs) – Form B: Future use request (patient identity unknown)
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Use Form B when a non-marketed drug must be on site before a medical emergency and the patient is not yet identified, such as stock for a hospital emergency department. Form A is for an identified patient. Form B requires a clinical rationale for why the drug is needed in advance.
Part 2 of Section C asks for the quantity remaining on hand, whether expired stock is being replaced, and a tracking list for the previous supply: patient initials, unborn child status, date of birth, sex, indication, new or repeat status, dosage, quantity and dates of administration.
The Special Access Program does not authorize payment. Health Canada's guidance says the decision to charge for an SAP-authorized drug rests with the manufacturer; some drugs are provided free, and others are paid by hospitals, public or private insurers, or sometimes patients.