- 5 -
- 4 -
An example of a treatment diary:
1
Treatment
Day
Number
2
Date
3
Time
4
Pen Volume
450 IU/0.75 mL
5
Prescribed
Dose
6
7
8
Dose Feedback Window
Amount Set to
Inject
Amount Displayed After Injection
#1
10
/
06
07
:
00
450 IU
175
175
if "0",
injection complete
if not "0", need second injection
Inject this amount ............using new pen
#2
11
/
06
07
:
00
450 IU
175
175
if "0",
injection complete
if not "0", need second injection
Inject this amount ............using new pen
#3
12
/
06
07
:
00
450 IU
175
175
if "0",
injection complete
if not "0", need second injection
Inject this amount ............using new pen
#3
12
/
06
07
:
00
450 IU
N/A
75
if "0",
injection complete
if not "0", need second injection
Inject this amount ............using new pen
75
Note:
The 300 IU pen maximum single-dose setting is 300 IU; the 450 IU pen maximum single-dose setting is
450 IU; the 900 IU pen maximum single-dose setting is 450 IU.
2. How to use your GONAL-f pre-filled pen Treatment Diary
A treatment diary is included on the last page.
Use the treatment diary to record the amount of injected IUs you use each time.
•
Record the treatment day number (1), date (2) and time (3) of your injection.
•
In the first line of the table the volume of your pen is already recorded for you (4).
•
Record your prescribed dose in the ‘’Prescribed Dose’’ section (5).
•
Verify you dialed the right dose before injecting (6).
•
After injection, read the number shown in the
Dose Feedback Window
.
•
Confirm you receive a complete injection (7) or record the number shown in the
Dose Feedback
Window
if other than ‘’0’’ (8).
•
When needed, inject yourself using a second pen, dialing your remaining dose written in the ‘’Amount
Displayed After Injection’’ section (8).
•
Record this remaining dose in the
‘’Amount Set to Inject’’
section in the next row (6).
CAUTION:
Using your treatment diary to record your daily injection(s) allows you to verify every day
that you received the full prescribed dose.
