Frankie Goes To Hollywood - Two Tribes - ZTT - 12 ZTAS 3

Product Information

A pharmacist who is involved in the treatment of patients with Zaponex® (clozapine) and registered with ZTAS who is not the recommended and the decision to start will be your own responsibility. We request you to also submit an off-licence agreement. Initial blood result cannot be more than 10 days old to start clozapine. Another sample MUST be taken within 10 days of most recent blood results will be provided by the transferring monitoring organisation. For On-Treatment patients who have

is outside the terms of the Marketing Authorisation and considered "Off-licence". In such situations, use of clozapine is not this decision, I have taken into account the views of the patient's relatives/caregivers and, where For On-Treatment patients transferring from the Clozaril or Denzapine brand of clozapine, the monitoring history and 3 used now or in the future in connection with further research by Leyden Delta (or sponsors whether or not associated with Leyden CNRD will be held for the sole purpose of preventing re-exposure to clozapine and will only be made available to the suppliers ofDelta). Such purposes may or may not be related to Zaponex and/or services connected to it and may also be published (your patient's blood results and to assist you and/or other healthcare professionals to make medical decisions regarding your patient's transferred from abroad, the start date of clozapine treatment and the monitoring history must be provided to ZTAS separately; If the Indication for use is 'Other', the patient is under the age of 16 years, if treatment with clozapine is contra-indicated, Clozapine use outside the terms for use as described in the Zaponex Product Information (e.g use in a

Clozapine usage in patients under 16 years of age is not recommended and will be considered Off-Licence. to my patient/guardians that his/her information and blood samples relating to him/her will be processed as described above and health and to provide you and/or your patients with services connected with ZTAS. Your patient's data and blood samples may bepatient will not be identified in any publications resulting from such research). The information on your patient held on the Local results must be analysed by a NEQAS (National External Quality Assurance Scheme) or equivalent certified The information you provide about your patient will be held on the ZTAS database and constitutes their personal and special category I certify that, to the best of my knowledge, the information provided is true and accurate. I confirm that I have explained Or other relevant specialist in the context of Zaponex® (clozapine) treatment indications, as per SPC

OR if the patient is taking any other medications contra-indicated for concomitant use with clozapine, then the use of Zaponex®patient on contra-indicated co-medication or diagnosed with a non-registered indication) applies to the