Prior Authorization Auto-Fill

Upload clinic notes. Get a completed prior auth form in seconds, not hours.

8 Specialty Drugs

6 Canadian Insurers

43 Form Combinations

PHIPA Compliant

PIPEDA Compliant

Data Processed in Ontario, Canada

Select Drug & Upload Documents

Choose the drug and insurer, then upload patient documents for extraction.

Asthma Biologics

Benralizumab

Fasenra

Dupilumab

Dupixent

Mepolizumab

Nucala

Tezepelumab

Tezspire

Omalizumab

Xolair

Interstitial Lung Disease

Nintedanib

Ofev

Pirfenidone

Esbriet

Drug

Insurer

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Review Extracted Data Demo Mode

All values below were extracted from your documents. Edit any field before filling.

01 — Patient Info

First Name

Last Name

Date of Birth

Address

City

Province

Postal Code

Phone (Home)

Phone (Mobile)

02 — Insurance

Member ID

Plan Number

Contract Number

Certificate Number

Employer / Plan Name

Relationship

03 — Prescriber

Saved Profile

First Name

Last Name

Specialty

License #

Phone

Fax

Address

City

Province

Postal Code

04 — Clinical Values

Diagnosis

Treatment Duration

Medical Rationale

Renewal request

05 — Treatment History

Previous therapies extracted from clinical documents.

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fields filled

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