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Reddy-Pomalidomide Patient Medication Information

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Reddy-Lenalidomide Patient Medication Information

Pharmacy Registration Form

Healthcare Provider Letter

Counselling Tool for Pharmacist

Confidential Survey for Prescriber

Reddy-Pomalidomide Patient Guide

Reddy-Lenalidomide Patient Guide

Pregnancy Report Form

Prescriber Guide

Prescriber Registration Form

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Reddy-Pomalidomide Confidential Survey for Females with Child Bearing Potential

Reddy-Lenalidomide Confidential Survey for Females with Child Bearing Potential

Confidential Survey for Prescriber

Keep a copy of this survey for your records.

Prescriber ID:
Patient ID:
Name of the treatment:

To make these Risk Management Educational Programs more effective, Dr. Reddy’s Laboratories Canada Inc. is conducting this survey and your participation is requested:

1. Have you counseled your patient on the teratogenic effects of their respective treatment (Reddy-Lenalidomide or Reddy-Pomalidomide)?
1. Yes
2. No
2. If this is the initial prescription, have you administered two serum pregnancy tests prior to writing the prescription?
1. Yes
2. No
3. Not Applicable
3. Were the results of the pregnancy tests negative?
1. Yes
2. No
4. What was the date of the patient’s last negative pregnancy test?
5. At the time of their initial visit, do you offer your patients a detailed discussion of educational material so that they understand the serious side effects?
1. Yes
2. No
3. I prefer not to answer
6. vi) At the time of prescribing Reddy-Lenalidomide or Reddy-Pomalidomide, what teratogenic side effects in particular should you warn your patients about
1. Fetal abnormalities
2. Spontaneous abortion
3. Both of the above
4. None of the above
7. Prescriptions of Reddy-Lenalidomide or Reddy-Pomalidomide for women of childbearing potential must be:
1. Limited to 30 days of treatment
2. Limited to 45 days of treatment
3. No limitation throughout the course after one negative pregnancy test
4. Dispensed within 7 days of the medically supervised negative pregnancy test
5. a & d
6. c & d

For more information about Reddy-Lenalidomide and Reddy-Pomalidomide, and their respective Risk Management Programs , please visit  www.reddy2assist.com or call  for assistance at 1-877-938-0670.

Return this form completed to Dr. Reddy’s Laboratories Canada Inc. via email, fax or mail:

Rx Infinity, Attn: Reddy2Assist Program
5155 Spectrum Way, Unit 29,
Mississauga ON L4W 5A1
Phone: 1-877-938-0670
Fax: 1-877-938-0807
Email: reddy2assist@drreddys.com
Website: www.reddy2assist.com

Keep a copy of this survey for your records.

Confidentiality Statement

The information in this document is confidential and the property of Dr. Reddy’s Laboratories Canada Inc.

No part of it may be transmitted, reproduced, published or used by any person/s without prior written authorisation from Dr. Reddy’s Laboratories Canada Inc.

This Reddy-Lenalidomide RMP Program and Reddy-Pomalidomide RMP Program: PRESCRIBER SURVEY is downloaded from www.reddy2assist.com, where more information about Reddy-Lenalidomide (lenalidomide), and Reddy-Pomalidomide (pomalidomide) and their respective Risk Management Program can be found.