Male Hypogonadism
29 de março de 2021Intrinsic Sleep Disorders
29 de março de 2021Checklist for Therapeutic Use Exemption (TUE) Application:
Intravenous Infusions
Prohibited Substances/Method: Volume > 100 ml per 12 h
This Checklist is to guide the athlete and their physician on the requirements for a TUE application that will allow the TUE Committee to assess whether the relevant ISTUE Criteria are met.
| • | TUE Application form must include: | |
| • | All sections completed in legible handwriting | |
| • | All information submitted in [language] | |
| • | A signature from the applying physician | |
| • | The Athlete’s signature | |
| • | Medical report should include details of: | |
| • | Medical history: symptoms at manifestation, course of disease, start of treatment. Must define/describe where the infusion was/is to be administered (Note: infusions given as part of hospital treatment, surgical procedure or diagnostic procedure do not require a TUE unless they contain a prohibited substance) |
|
| • | Findings on examination: e.g., physical signs of illness or relevant medical condition | |
| • | Interpretation of symptoms, clinical findings and test results | |
| • | Diagnosis of illness or most probable medical condition | |
| • | Infusion: volume and time period over which it has been given (only >100ml per 12h require a TUE) and substance (if any prohibited substance is infused) including dosage and frequency |
|
| • | Response to treatment/course of illness/condition | |
| • | If an alternative treatment was not an option, a description of why iv administration of fluid or substance was/is chosen must be given | |
| • | Diagnostic test results included (copies of originals or printouts) | |
| • | Laboratory tests: if available, e.g. Hb/Hct, electrolytes, blood cell count, serum ferritin etc | |
| • | Additional information included | |
| • | As per ADO specification | |
Please note that the completed TUE application form alone is not sufficient; supporting documents MUST be provided. A completed application and checklist DO NOT guarantee the granting of a TUE. Conversely, in some situations a legitimate application may not include every element on the checklist.
