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Pmb cdl conditions

CDL Condition
Clinical Entry Criteria / Information required
• Dx required by specialist physician, paediatrician or endocrinologist, or state hospital provider • All other disciplines, to submit pathology confirming the diagnosis • Spirometric demonstration of at least partially reversible airflow obstruction (adults and children > 5 years) • Changes in peakflow in response to a B2-agonist • Diagnosis to be confirmed by a psychiatrist • the primary psychiatric diagnosis/condition • co-morbid psychiatric conditions contributing • any other medically contributing conditions • Psycho-social (e.g. drug and alcohol abuse, environmental factors etc.) • Anti-microbial agents subject to culture and sensitivity/ antibiograms, excluding macrolides which are added as part of treatment of • NYHA stage (if available) and/or Ejection Fraction (echocardiogram results) • Sub-type must be specified - Dilated Congestive, Hypertrophic or Restrictive type • NYHA stage (if available) and/or Ejection Fraction (echocardiogram results) • Spirometric tests results - GOLD guidelines applied • Clinical risk profile (e.g. smoking and exacerbation history) • Antibiogram for non-first line antibiotics or history of use CDL Condition
Clinical Entry Criteria / Information required
• ICD-10 code and specialist physician (or nephrologist) Rx required • submit FBC and phosphate levels for consideration for EPO *If the patient's age, body weight and serum creatinine are known, the creatinine clearance can be calculated as follows: Clcreat = (140 - age [yr]) x body wt [kg]) • Angina pectoris with supportive findings on ECG (exercise or stress), Duke Treadmill test, echocardiography or angiography • Evidence of Acute Coronary Syndrome (date and type of event: acute MI, subsequent MI, coronary angioplasty, unstable angina, stent insertion, • Lipogram or Total choloesterol (not finger prick blood test) • Dx required by specialist physician, paediatrician, surgeon, gastroenterologist, or state hospital provider • Dx required by specialist physician, paediatrician, neurosurgeon, neurologist, endocrinologist, or state hospital • If age of onset is <16 y and insulin only - Dx accepted from Dr or pharmacy • If age of onset is ≥ 16y - in both symptomatic and asymptomatic patients the diagnosis is based on the following • plasma venous blood values (not fingerprick) values: • Random blood glucose, fasting blood glucose at initiation; HbA1c needed six(6) monthly thereafter • Patient must need insulin only (not on oral treatment at all) • If patient starts with a sulphonylurea (SU) only - Dx accepted from Dr or pharmacy • If patient starts with metformin (MET), glitazone (TZD), gliptin (DPP4-I) or any other Tx* - in both symptomatic and asymtomatic patients the diagnosis is based on the following plasma venous blood (not fingerprick) values: • Random blood glucose, fasting blood glucose at initiation; HbA1c needed six(6) monthly thereafter • In cases where the patient is already on therapy (and hence RBG or FBG not available), due to diagnosis long ago, the HbA1c may be accepted for * To exclude cases where these drugs are used for glucose intolerance, metabolic syndrome, insulin resistance or PCOD, but patient does not have • ECG results to be submitted by the treating doctor CDL Condition
Clinical Entry Criteria / Information required
• Complete clinical history of the seizures; EEG tests results if available or where clinical history is not clear • If history of Bipolar, Schizophrenia, Depression, Neuropathy or Migraine authorisations and/or claims for drugs for these conditions: EEG/specialist report, or neurologist to confirm Dx telephonically • Laboratory report showing Factor VIII and IX levels • Haematologist, physician's or state hospital Rx required • The South African Antiretroviral Treatment Guidelines 2013, Version 14 March 2013, apply • Details of any symptomatic atherosclerotic disease and CV events, such as: • Occlusion/stenosis of peripheral arteries; severity classification of PAD • Blood pressure readings: at least 2 readings on different dates (at least 3/12 apart), unless BP is >180/110 or patient is at very high risk (see 3rd bullet), in which case one BP reading is sufficient • Clinical risk profile (information on associated CV conditions such as CAD, Diabetes, Heart failure, CKD, Stroke, PVD, Retinopathy, Chronic Kidney Disease - if patient is not yet registered for one or more of these) • Baseline (pre-treatment) lab report with TSH value required – patient only to be registered if TSH is above upper limit of normal (may vary from • If patient is ≤ 50 years – Lab report showing LH, FSH, Oestradiol-17β and progesterone levels • Dx required by specialist physician, neurologist, or state hospital provider • EDSS and subtype of disease to be specified • Dx required by specialist physician, neurologist, or state hospital provider • The initial diagnosis may be confirmed by any registered doctor • Access to second and third level items will require intervention by a neurologist or physician CDL Condition
Clinical Entry Criteria / Information required
• If no DMARDs: The initial diagnosis may be confirmed by any registered doctor, provided that the diagnosis is confirmed with diagnostic proof • Access to second and third level items will require intervention by a specialist physician, paediatrician or a rheumatologist • Dx required by psychiatrist, paediatric psychiatrist, or state hospital provider • Dx required by specialist physician, paediatrician, rheumatologist, or state hospital provider • Dx required by specialist physician, surgeon, gastroenterologist, or state hospital provider Additional Chronic
Clinical Entry Criteria / Information required
Conditions
• Only funded on selective options from the chronic benefit • Two reports from 2 independent clinicians, one of whom must be a child psychiatrist • A teacher's report as well as the child psychiatrist report will be acceptable • Only funded on selective options from the chronic benefit • The diagnosis must clearly state all of the following: • The primary psychiatric diagnosis/condition • Co-morbid psychiatric conditions contributing • Any other medically contributing conditions • Pscyho-social (e.g. drug and alcohol abuse, environmental factors etc.) • Additional clinical information required: • HAM-D score must be submitted at initial diagnosis and thereafter on six(6) monthly follow up consultations • Requests for continuation of second and third line therapy must be accompanied by HAM-D score every 3 to 6 months thereafter • Only funded on selective options from the chronic benefit • The diagnosis must be confirmed by a neurologist.
• Only funded on selective options from the chronic benefit • The diagnosis must be confirmed by a dermatologist

Source: http://www.resomed.co.za/links/PMB%20CDL%20Conditions.pdf

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