Shared Care Guideline Sample Contracts

Shared Care Guideline
Shared Care Guideline • April 5th, 2021

Mycophenolate mofetil (Adults) for the treatment of autoimmune disease Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of Mycophenolate for indications listed below. Indication This is a guideline for unlicensed use of mycopheolate mofetil in the treatment of certain autoimmune diseases: • Rheumatology (connective tissue disease and vasculitis)• Dermatology (SLE, dermatomyositisis and polymyositisis, severe psoriasis, severe atopic dermatitis, blistering conditions such as pyoderma ganrenosum and autoimmune bullour dermatoses such as pemphigus)• Gastroenterology (ulcerative colitis)• Ophthalmology services (uveitis, scleritis, ocular sarcoidosis). Licensing information Prophylaxis of acute transplant rejection in patients receiving allogeneic renal, cardiac or hepatic transplants. Note: this licensed indication is not covered by this shared care Guideline. Dosage and administration Starting

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Shared Care Guideline
Shared Care Guideline • January 17th, 2022

Mycophenolate mofetil (Adults) for the treatment of autoimmune disease Introduction This shared care agreement outlines the responsibilities between the specialist and the generalist for managing the prescribing of Mycophenolate for indications listed below. Indication This is a guideline for unlicensed use of mycopheolate mofetil in the treatment of certain autoimmune diseases: • Rheumatology (connective tissue disease and vasculitis)• Dermatology (SLE, dermatomyositisis and polymyositisis, severe psoriasis, severe atopic dermatitis, blistering conditions such as pyoderma ganrenosum and autoimmune bullour dermatoses such as pemphigus)• Gastroenterology (ulcerative colitis)• Ophthalmology services (uveitis, scleritis, ocular sarcoidosis).• Hepatology (autoimmune hepatitis) Licensing information Prophylaxis of acute transplant rejection in patients receiving allogeneic renal, cardiac or hepatic transplants. Note: this licensed indication is not covered by this shared care Guideline.

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