Medication Access Program

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:
1. Patient Consent Form
2. Patient/Physician Information Sheets
3. Authorization for Use & Disclosure Health Information Form

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 MAP:

Medication Access Program (MAP)
UGA Clinical Pharmacy Program
Medical College of Georgia - CJ-1020
Augusta, GA 30912-2450
Phone number: (706) 721-0131
Fax number: (706) 721-0754

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