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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

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Reddy-Pomalidomide Confidential Survey for Females with Child Bearing Potential

Reddy-Lenalidomide Confidential Survey for Females with Child Bearing Potential

Reddy-Pomalidomide Confidential Survey for Females with Child Bearing Potential

Keep a copy of this survey for your records.

(For females of child-bearing potential only)

Patient ID:

To make this Risk Management Educational Program more effective, Dr. Reddy’s Laboratories Canada Inc. is conducting this survey and your participation is requested. Your answers will not affect your ability to receive Reddy-Pomalidomide. Your answers and personal information will be kept confidential and anonymous. Mandatory surveys are required for Females of Child-Bearing Potential and prescribers of Females of Child-Bearing Potential only (initially and monthly thereafter):

1. Did you receive any educational material for Reddy-Pomalidomide?
1. Yes
2. No
2. Where did you receive this information?
1. Physician’s office
2. Pharmacy
3. Online on www.reddy2assist.com
3. Did you/your partner read the educational material?
1. All
2. Most
3. Some
4. None
4. Did you understand the risks associated with Reddy-Pomalidomide?
1. All
2. Most
3. Some
4. None
5. Females must not get pregnant
1. while taking Reddy-Pomalidomide
2. while taking Reddy-Pomalidomide and at least one month after stopping the treatment
3. while taking Reddy-Pomalidomide and at least six months after stopping the treatment
4. I don’t know
6. Reddy-Pomalidomide can cause
1. Birth defects (deformed babies)
2. Miscarriage, premature birth, or death of the baby
3. Both of the above
4. I don’t know
7. A female seeking Reddy-Pomalidomide treatment:
1. Must have pregnancy tests regularly
2. Should use at least two forms of effective contraception
3. None of the above
4. All of the above
5. I don’t know
8. Which one of the following are highly effective forms of contraception:
1. Tubal ligation
2. Partner’s vasectomy
3. Intrauterine device (IUD)
4. All of the above
5. I don’t know

For more information about Reddy-Pomalidomide and the Reddy-Pomalidomide RMP program, please visit our website or call Dr. Reddy’s Laboratories Canada Inc. at 1-877-938-0670.

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

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 

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-Pomalidomide RMP Program: PATIENT SURVEY is downloaded from www.reddy2assist.com, where more information about Reddy-Pomalidomide (pomalidomide) and the Reddy-Pomalidomide (pomalidomide)RMP Program can be found.