Rems Agreement Form

Your doctor will advise you on why you and your partner should prevent your pregnancy. Your doctor will also advise you not to share the medication, not to donate blood or semen, and to use appropriate contraception. They should be advised not to treat or open REVLIMID capsules® lenalidomide. For more information on the needs of the RevLIMID REMS program, see www.CelgeneRiskManagement.com or in the patient manual on the REMS REVLIMID program. A possible birth defect (deformed baby) or the death of an unborn baby. Women who are pregnant or wish to be pregnant should not take REVLIMID. . Your doctor will tell you how you take Revlimid. Follow your doctor`s instructions carefully.

Talk to your doctor or nurse if you have any questions. . The specialist pharmacy will contact you to advise you on the serious risks and safety conditions of REVLIMID before receiving your prescription. You also coordinate the delivery of REVLIMID to you REVLIMID will be delivered with a medication guide to the address you provide. A signature will be required to receive this shipment Your doctor will send your prescription to a specialized pharmacy. Health care providers must be certified in the Vigabatrin REMS program to prescribe branded sabril or generic vigabatrin. . You and your doctor will then complete the revlimid® (lenalidomide) patient-physician contract form. You don`t need to do a survey for your first recipe, but for the following.

Visit www.CelgeneRiskManagement.com or call 1-888-423-5436 and press 1 to do your survey. Before receiving revlimid, you must be registered in the REVLIMID REMS program. There are specific requirements for men and women in the program. . If you are able to be pregnant, you must perform a first pregnancy test within 10-14 days of receiving a RECIPE REVLIMID Note: Prescription persons registered in the Sabril REMS program will be moved to the new Vigabatrin REMS program without the need to identify them.