Your online Starter Kit
Initiate and continue patients on PrJINARC®
Physician
Co-sign PPAF with patient
Provide prescription and LFT orders for HSMD Programme:
Every month for 18 months*
ORIJIN® Team
Receives, validates and stores PPAF
Contacts patient to confirm enrolment and understanding
of HSMD Programme
Ships supply of JINARC to pharmacy for dispensing if all PPAF conditions are met
Sends blood test reminders to patient (as per patient preference)
Conducts follow-up
of LFT result status
with prescriber, using the LFT fax-back form
Key resources
Prescriber’s Guide
Your guide to discussing and prescribing JINARC.
Patient Information Booklet
A guide for your patients to understanding, beginning and continuing treatment with JINARC.
Patient-Prescriber Agreement Form (PPAF)
Submit the PPAF to ORIJIN by fax at 1-844-3JINARC (1-844-354-6272) or email at Orijin@supportprogram.com.
ORIJIN Patient Brochure
A brochure with information on the ORIJIN Patient Support Program and lifestyle tips for your patients.
Fact Sheet
A quick reference guide of JINARC’s key characteristics.
Nurse Checklist
A quick reference tool to facilitate initiation of JINARC for your patients.
HSMD LFT Fax-Back Form
A form to fill out your patients’ most recent LFT results and send back to the HSMD Programme.
HSMD: Hepatic Safety Monitoring and Distribution Programme for JINARC; LFT: liver function test; PPAF: Patient-Prescriber Agreement Form.
* Any adverse event should be reported to Otsuka Canada Pharmaceutical Inc. at 1-877-341-9245.