Healthcare Provider Downloads & Resources Access a comprehensive offering of the most common healthcare provider forms, lists and manuals. Accessible formats are available upon request to Human Resources. Pharmacy Pharmacy Modification FormFor any personal, office or banking changes, please complete and submit the pharmacy modification form. Pharmacy Provider ManualConsult the manual for more information on submitting pharmacy claims. Pharmacy Registration FormTo begin the registration process with Express Scripts Canada as a pharmacy provider, please complete and submit this form. Drug Recall ProtocolThe communication highlights protocols pharmacy providers are to follow in responding to a drug recall. Claim Form for drugs over $9,999.99Please complete, print and submit this form for drug claims over $9,999.99. Pseudo DINsConsult a list of pseudo DINs that correspond to the chemicals used for compounding Units of Measure Updates (Package Size) Pharmacy Provider Contacts Cognitive Service Fee Claims (Step Modules) IN Service Newsletter July 2019 (Rest of Canada) Group User ID Request Form for Online Statements Dentists Dental Hygienist Provider Enrolment FormTo begin the registration process with Express Scripts Canada as a dental hygienist, please complete and submit this form. Denturist Provider Enrolment FormTo begin the registration process with Express Scripts Canada as a denturist, please complete and submit this form. Dental Modification FormFor any personal, office or banking changes, please complete and submit the dental modification form. Group User ID Request Form for Online StatementsTo view statements for multiple professionals in one account, please complete and submit the Dental Group User ID Request Form. Extended Healthcare Group User ID Request Form for Online Statements Electronic Extended Health Care Claims Submissions Physicians Prior Authorization Program ESC Prior Authorization Program Drug ListThis document lists all the drugs subject to the ESC Prior Authorization Program. ESC Prior Authorization Program Request FormComplete this form to submit a Prior Authorization Request to ESC. Dynamic Therapeutic Formulary Dynamic Therapeutic Formulary Drug ListingThis document lists the most commonly prescribed drugs covered on DTF, and provides guidance on alternatives for drugs not covered on DTF. Dynamic Therapeutic Formulary Prior Authorization Drug ListThis document lists all the drugs subject to Prior Authorization within the Dynamic Therapeutic Formulary. Maintenance Medications Sample Maintenance Medications ListNot sure if your medication is considered maintenance? Check here for a sample list of our maintenance medications.