---
title: CAR-T Cell Therapy Supportive Medication Refill Form Template | Paperform
description: Comprehensive medication refill form for CAR-T therapy patients with cytokine release syndrome monitoring, neurotoxicity screening, and cellular therapy team coordination.
url: "https://paperform.co/templates/car-t-cell-therapy-supportive-medication-refill-form"
type: static
generatedAt: "2026-03-28T00:43:15.168Z"
---

[← Back to free form templates](/templates/)    ![CAR-T Cell Therapy Supportive Medication Refill Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/car-t-cell-therapy-supportive-medication-refill-form.png)
    [Preview](https://_preview.paperform.co/ai-template/car-t-cell-therapy-supportive-medication-refill-form) [Use this template for free](/create?ai-template=car-t-cell-therapy-supportive-medication-refill-form)    [Application Forms](/templates/category/applications/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Pharmacist](/templates/role/pharmacist/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Streamline CAR-T Cell Therapy Medication Management with Paperform

Managing supportive medication refills for CAR-T cell therapy patients requires careful coordination between oncology teams, pharmacists, and patients. This **CAR-T Cell Therapy Supportive Medication Refill Form** provides a comprehensive digital solution for healthcare providers managing complex cellular therapy protocols.

CAR-T (Chimeric Antigen Receptor T-cell) therapy represents a breakthrough in cancer treatment, but it demands vigilant monitoring for complications like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). This form template integrates medication refill requests with essential safety screening, ensuring your cellular therapy team captures critical clinical data at every touchpoint.

#### Built for Oncology and Cellular Therapy Teams

This form is specifically designed for oncologists, hematologists, cellular therapy coordinators, and specialty pharmacists who manage CAR-T patients during the critical post-infusion period. The template includes:

 - **Structured CRS monitoring** with grading scales and symptom tracking
 - **Neurotoxicity screening** aligned with ICANS assessment criteria
 - **Medication reconciliation** for tocilizumab, corticosteroids, and supportive therapies
 - **Care team coordination** fields to ensure seamless communication
 - **Conditional logic** that adapts questions based on symptom severity

#### Enhance Patient Safety and Workflow Efficiency

By digitizing your refill process, you eliminate phone tag, fax delays, and missing information that can compromise patient safety. Paperform's conditional logic ensures that high-risk symptoms trigger additional screening questions, while integration capabilities let you route urgent cases directly to your cellular therapy team via Stepper workflows.

Connect this form to your EHR system, pharmacy management software, or secure team communication tools to create an automated triage pathway. You can also use Paperform's calculation engine to auto-score CRS and ICANS grades based on patient responses, flagging cases that require immediate clinical review.

#### GDPR and SOC 2 Compliant Infrastructure

While Paperform is not HIPAA compliant, many healthcare organizations in Europe, Australia, and other regions use Paperform's SOC 2 Type II certified infrastructure with appropriate safeguards for non-PHI workflows, pre-screening, and internal care coordination. Always consult your compliance team to determine the appropriate use case for your regulatory environment.

Whether you're managing a busy cellular therapy program or coordinating complex medication protocols, this template gives your team a professional, streamlined starting point that improves both patient experience and clinical safety.
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