Prescriber Registration

01

Account

Account Details

02

Declaration

Confirm your training

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Account Information

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* First name

* Last name

* Email

* Contact number

* Registration number

* Institution name

* Address

I have read and understood the privacy collection notice

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Confirm your training

I agree to implement the following risk minimisation procedures when dealing with prescriptions for Lenalidomide Viatris, as specified by Viatris in the Lenalidomide Viatris Healthcare Professional’s Information Booklet.

1. Lenalidomide Viatris will be dispensed, checked, and stored according to our standard documented procedures for oral anti-cancer medicines.

2. Prescriptions for Lenalidomide Viatris will be dispensed only if accompanied by a completed Lenalidomide Viatris Prescription Authorisation Form.

3. The prescribing will be limited to no more than a 4-week supply for women of childbearing potential and 12 weeks for males and women of non-childbearing potential.

4. The information supplied to Viatris on Prescription Authorisation Forms will be used to provide anonymized aggregate reports to the regulatory agencies to assess implementation of the pregnancy prevention programme.

5. I have read and understood the Lenalidomide Viatris Healthcare Professional’s Information Booklet.

Before prescribing or dispensing Lenalidomide Viatris, please review the Australian Approved Lenalidomide Viatris Product Information available from https://www.ebs.tga.gov.au/. I have read and understood the enclosed privacy statement and agree with it. I understand that information relating to an adverse event with a Viatris product that is identified during this activity will be forwarded to Viatris' drug safety department and possibly to health authorities when required. I understand that my participation in this activity indicates my consent for Viatris’ drug safety department to contact me for further information regarding any adverse event identified as part of this activity.