Program support materials and resources
Teva-Fentanyl Patch Return Sheet
The Teva-Fentanyl Patch Return Sheet is a secured patch return sheet for easy application and safe storage of Teva-Fentanyl patches. It has been designed with size markers to help easily identify the Teva-Fentanyl patches being returned. It has also been sized to fit into the patient’s prescription bag along with the patches being dispensed, and features additional adhesive to ensure used patches stick easily.
We have also made available a printable PDF that can be used as a return sheet. The sizing and images on this PDF match the exact size of the Teva-Fentanyl patch. If you wish to order Teva-Fentanyl Patch Return Program return sheets, please contact your Teva Canada Sales Representative.
Bag stuffers
Patient FAQs: This bag stuffer provides answers to patients’ frequently asked questions (FAQs) and can be distributed with the return sheet as a comprehensive overview of the Teva-Fentanyl Patch Return Program.
Patient FAQs
Teva-Fentanyl Application/Usage Instructions: This bag stuffer details instructions for proper use and application of the Teva-Fentanyl patch, with a helpful step-by-step guide.
Patient Introduction: This bag stuffer can be used to alert patients in advance that they will need to participate in the program.
Additional bag stuffers are available to order from your Teva Canada Sales Representative.
Pharmacist letter to physicians
We’ve produced this letter to offer pharmacists a quick way to communicate with their physician partners. The letter can be personalized and sent to a physician to introduce and highlight the benefits of the Teva-Fentanyl Patch Return Program to all stakeholders (pharmacists, physicians and patients).
Pharmacist letter to patients
Physician and pharmacist FAQs
This sheet reviews many of the FAQs asked by physicians and pharmacists, offering them ready answers to any questions they may receive.
Physician and pharmacist FAQs
Shared responsibility chart
This chart offers a quick overview and helpful reminder of pharmacist, physician and patient responsibilities in managing the Teva-Fentanyl Patch Return Program.
Shared responsibility chart
Teva-Fentanyl Patch Identifier
A removable static poster, the Teva-Fentanyl Patch Identifier allows pharmacists and their staff to quickly determine if returned patches have been altered or are counterfeit.
Download as a PDF for your reference only. The sizing and images on this PDF do not print to the exact size of the Teva-Fentanyl patch. For exact sizing and identification of returned patches, always use the Teva-Fentanyl Patch Identifier provided in your starter kit. To order a Teva-Fentanyl Patch Return Program starter kit or additional patch identifier posters, please contact your Teva Canada Sales Representative.
Please note that the images on the poster depict unused patches. When patients return used patches, you will not see the wavy line marking as indicated on the Teva-Fentanyl Patch Identifier poster. This marking is part of the release liner that is discarded when a patient uses the patch. To confirm the authenticity of returned patches, please only compare them against patch size and prescription marking on the Teva-Fentanyl Patch Identifier poster. Please download the attached PDF for more information.
Emergency contact card
This card reminds patients to dial 911 or contact emergency services in the event of a fentanyl overdose.
Emergency contact card
Treatment agreement
A patient will receive this document when being counselled by a physician or pharmacist on fentanyl patch treatment. It outlines patient expectations while using Teva-Fentanyl patches and should be signed by the patient, physician and pharmacist.
Treatment agreement
Patch discrepancy form
This fillable PDF/fax form must be completed if a patient’s prescription returns with missing or altered patches. The pharmacist can use this form to notify the patient’s physician immediately.
Patch discrepancy form