If you would like to learnmore about this program,ask your pharmacist orhealthcare professional.

Use this sheet to keep and return ALL of your used patches.

Your pharmacist and doctor participatein the Fentanyl Patch Return Program.You must bring your USED fentanyl patches back to the pharmacy in order to pick up a new prescription of your patches.

Instructions:

1. Once you remove a used patch from your skin, stick the used patch on this sheet in the designated boxes.

2. Store this sheet out of sight and out of reach of children/pets.

3. After applying your last patch, returnthis sheet with the used patches tothe pharmacy in order to pick up yournext supply.

Sandoz Canada Inc. 145 Jules-Léger, Boucherville QC J4B 7K8Customer Service: 1-800-361-3062 or 514-596-0000www.sandoz.ca

Customer Service: 1-800-361-3062 or514-596-0000

Safety First

Help make ourcommunity safer!

N Sandoz® FentanylPatch Return Sheet

Thank you for helping make ourcommunity safer!

Patient Rx Label

Number of patches returned:

Date returned: DD / MM / YYYY

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA

Place used patch here.

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA

Place used patch here.

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA

Place used patch here.P

lace

use

d pa

tch

here

.

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA

Pla

ce u

sed

patc

h he

re.

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA

Pla

ce u

sed

patc

h he

re.

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA

N Sandoz® FentanylPatch Return Sheet

Pla

ce u

sed

patc

h he

re.

12 mcg/h 5TTSS CA

25 mcg/h 5TTSS CA

37 mcg/h 5TTSS CA

50 m

cg/h

5T

TS

S C

A

75 mcg/h 5TTSS CA

100 mcg/h 5TTSS CA