Phone: 706.721.0131 OR 1.800.736.2273 ext.0131 Fax: 706.721.0754


To be eligible for MAP's services, the patient must:

  1. Be a solid-organ transplant patient
  2. Reside in the State of Georgia

Please complete the following forms to apply for MAP:

Patient / Physician Information Sheets Patient / Physician Information Sheets

HIPAA Authorization Form HIPAA Authorization Form

Patient Consent Form 17 Patient Consent Form 17

You must also read the HIPAA Policy page for a full understanding.

If you would like for MAP to help you enroll a patient into a medication assistance program, please complete, print and mail or fax the HIPAA Authorization form, information data sheet and the patient consent form to:

Medication Access Program (MAP)
UGA Clinical Pharmacy Program
Augusta University Medical Center
Solid Organ Transplant Center
1120 15th Street, AD-3430
Augusta, GA 30912-2450

Phone number: (706) 721-0131
Fax number: (706) 721-0754
E-Fax number: (706) 446-2810

Tips for Effective Correspondence to MAP

Please have the following information available when you contact MAP:

  • Patient's name
  • Patient's address
  • Patient's telephone number
  • Patient's social security number
  • Patient's date of birth
  • Patient's date of transplant
  • Patient's household income amount
  • Medications that the patient is taking
  • Patient's medication dosage
  • Physician's name
  • Physician's address
  • Physician's telephone number
  • Transplant center following patient