This short checklist is designed to help you and your pharmacist discuss Avarante and decide whether it is right for you. It should be completed as accurately as possible so that the pharmacist can give you the most appropriate advice and/or treatment. Please answer all of the questions by ticking the box that applies. The answers are needed to ensure that Avarante can be supplied appropriately, as it may not be suitable for you if you are taking certain medications or have certain medical conditions. The pharmacist will discuss the questions and your answers with you so any notes you make will help with this. If the pharmacist supplies Avarante to you, please read the leaflet carefully.

This Pharmacy Checklist Quick Guide is provided to assist you in your assessment of a patient’s suitability for Avarante.

It is designed to be used in conjunction with the Avarante Checklist. The Avarante Checklist can be provided to the patient to complete before consultation with you or it can be used as part of your consultation with the patient.

After assessing your customer using the Avarante Pharmacist Checklist Quick Guide, complete and supply them with either the Repeat Purchase Card or Referral Card.

After assessing your customer using the Avarante Pharmacist Checklist Quick Guide, complete and supply them with either the Repeat Purchase Card or Referral Card.

This booklet, together with the Checklist and Pharmacist Checklist Quick Guide (which helps with the interpretation of the patient’s answers), has been developed by Viatris to support pharmacists and pharmacy assistants in managing the risks related to

Avarante and enabling its appropriate supply and use.

This document contains key information to help you identify patients to whom you can supply Avarante, and the advice you should give to help them use the product appropriately.