Novocure Medical Hub Expanded Access & Compassionate Use Form

Country^*

Any personal data obtained of both the prescribing HCP and the patient will be solely used by Novocure for the purpose of handling your request to be included in the expanded access program. Access to this persona data will only be provided to a limited number of Novocure personnel for the sole purpose of evaluation and determining eligibility for this program. If eligibility for this program meets Novocure’s internal requirements, the personal data may then be shared with country specific regulatory agencies for final approval. If approved, you will receive a Service Agreement and Intake Form which will include more information about Novocure’s handling of your personal data during the treatment and on data privacy and protection.

Please note that recipients of any personal data required for this process may reside in countries that do not have the same level of data privacy protection as your country of residence. Novocure takes all reasonable and appropriate steps to secure your personal information from unauthorized access or disclosure. Information will be stored for a period of ten years after the last interaction with Novocure (i.e., on the provision of feedback if the request is denied OR on the completion of the final product supply or follow-up if the request is approved).

Should any information detailing any side effects involving a Novocure device be included in this request form, we may need to contact the prescribing physician to follow up as per regulatory requirements.

Expanded Access & Compassionate Use Request

General Information

Patient Information - Please do not include any additional patient identifiers.

Demographics

Medical History

Please do not include any additional patient identifiers.

Current Request