Imnovid®▼ (pomalidomide) Male Treatment Initiation Form

For Healthcare Professionals

This Treatment Initiation Form must be completed for each male patient prior to the initiation of their pomalidomide treatment. It is mandatory that male patients receive counselling and education to be made aware of the risks of pomalidomide. The aim of the Treatment Initiation Form is to protect patients and any possible foetuses by ensuring that patients are fully informed of and understand the risk of teratogenicity and other adverse effects associated with the use of pomalidomide.