In patients who have failed on second line treatment, an application for third line ARV treatment needs to be sent to the central committee for review. Here’s how it’s done:

1. Download the PDF. Click here to go the link. Please do not print out the document to complete by hand.
2. Open the PDF document using Adobe Reader. Ensure you have the latest version of the form may not work properly (see below for link and installation instructions).
3. This is an editable PDF. Fill in all fields. The minimum required fields will be highlighted. Please click on each field and enter the required patient information.
4. Once you have completed the document please save it to your computer by clicking the save icon on the top left of the screen.  Save it using the patient name and surname as a unique identifier.
5. Submit. Close Adobe and attach the completed and renamed application form to an email and submit it to the following email address: TLART@health.gov.za

Please note that, In order to open the application form, you will need the latest Adobe Reader installed on your computer. If you don’t have it, please download it from the Adobe website.

For any queries please contact the committee at TLART@health.gov.za