Metoject® Home Care & Support Services

All Metoject® patients can access either or both Metoject® Homecare Services in Ireland (Free of charge)

Nurse Final Icon

Nurse to train patients’ in their home & at their convenience.

Sharps Bin Icon

A sharps waste disposal service to discard used Metoject® PENS is available. Sharp bins are delivered to and from the patients’ home (carried out by our licensed contractor).

For a replacement sharps bin please contact Fannin on 1800 937628. Please note that only used Metoject Pens can be placed in the sharps bin provided.

Sharps_Bin

Register My Patient For Home Services

I am a Dr / Nurse
I am a Pharmacist
medac-Metoject-Pen-logo

CONFIDENTIAL

Metoject® Pen Homecare -  HCP Referral Form

Metoject® Pen Homecare Pop-Up Patient Referral Form - CONFIDENTIAL
Please select which option(s) you require: *

SECTION A. PATIENT INFORMATION

Patients Home Address *
Patients Home Address
Address 1
Address 2
City
County
Postcode/EirCode
Mobile or Landline
Has the patient been prescribed Metoject Pen? *

SECTION B. REFERRING CLINICIAN INFORMATION

Mobile or Landline Number

SECTION C. INDICATION & PRESCRIPTION INFORMATION

Prescription - Please indicate the presentation of Metoject® 50mg/ml PEN prescribed *
Please note these are the only available presentations
Is the patient currently on Oral Methotrexate? *
If ‘Yes’, please indicate the day the Oral Methotrexate medication is taken *
Is the patient currently on any other medication?
I have discussed the Metoject® PEN Homecare Service with the patient and, they have given their consent to receive the service. *
Patient agrees for their personal data to be sent to our approved licensed Metoject® PEN Homecare service providers: Point of Care (nurse training) and/or, SRCL (sharps waste disposal). *

 

All data held by Fannin Limited and their approved license contractors, is for the sole purpose of these Metoject® services
and, is in accordance with the Data Protection Act 1998 and 2003.

Pharma Division, Fannin Limited,
Fannin House, South County Business Park, Leopardstown, Dublin 18
Tel: 01 290 7000/7069 Fax: 01 290 7216 Email: metoject@fannin.eu

medac-Metoject-Pen-logo

CONFIDENTIAL

Metoject® Pen Homecare -  Retail Pharmacy Patient Referral Form

Metoject® Pen Homecare Retail Pharmacy Referral Form - CONFIDENTIAL
Please select which option(s) you require: *

SECTION A. PATIENT INFORMATION

Patients Home Address *
Patients Home Address
Address 1
Address 2
City
County
Postcode/EirCode
Mobile or Landline
Has the patient been prescribed Metoject Pen? *

SECTION B. REFERRAL INFORMATION

Pharmacy Address *
Pharmacy Address
Address 1
Address 2
City
County
Postcode/EirCode
Mobile or Landline Number

SECTION C. INDICATION & PRESCRIPTION INFORMATION

Is the patient currently on Oral Methotrexate? *
If ‘Yes’, please indicate the day the Oral Methotrexate medication is taken *
Prescription - Please indicate the presentation of Metoject® 50mg/ml PEN prescribed *
Please note these are the only available presentations
Is the patient currently on any other medication?
I have discussed the Metoject® PEN Homecare Service with the patient and, they have given their consent to receive the service. *
Patient agrees for their personal data to be sent to our approved licensed Metoject® PEN Homecare service providers: Point of Care (nurse training) and/or, SRCL (sharps waste disposal). *

All data held by Fannin Limited and their approved license contractors, is for the sole purpose of these Metoject® services
and, is in accordance with the Data Protection Act 1998 and 2003.

Pharma Division, Fannin Limited,
Fannin House, South County Business Park, Leopardstown, Dublin 18
Tel: 01 290 7000/7069 Fax: 01 290 7216 Email: metoject@fannin.eu