HealthRX.com · Printable question sheet
Tesamorelin compounding pharmacy quality questions
Use this sheet before you fill or refill a compounded tesamorelin prescription. Write down the pharmacy and product details, then take the sheet to your pharmacist or prescriber to check licensing, product source and labeling.
Pharmacy and product details
Copy these exactly from the label, invoice or prescription.
Pharmacy nameAs printed on the label or invoice
Pharmacy license numberWrite the number exactly as shown
Prescriber nameDoctor or nurse practitioner on the prescription
Product name as labeledFor example Egrifta SV or compounded tesamorelin
Vial strength shown on labelWrite what the label states
Confirm before you accept the product
Bring these to the visit or ask for them in writing.
- Write down whether the seller says the product is FDA-approved or FDA quality-checked
- Check whether the seller treats Egrifta SV and Egrifta WR as the same product
- Confirm the pharmacy's state license or outsourcing facility status in writing
- Note whether the product appears on any FDA list the pharmacy relies on
- Bring the prescription and the product label to the visit
- Confirm who will check glucose and growth factor levels during therapy
Questions to ask the pharmacist or prescriber
- Is this product FDA-approved, and can you show me where that is stated?
- Which FDA list do you rely on to decide this product is allowed to be made?
- Who tested this batch for strength and sterility, and where are the results?
- Is this made in a state-licensed pharmacy or a registered outsourcing facility?
- Are you offering a compounded product in place of an approved Egrifta product?
- How will my blood sugar and growth factor levels be checked during therapy?
- Will you tell me in writing if the product source or formula changes?
Product checks at each refill
Record each delivery or refill and what you confirmed.
| Date received | Batch or lot label | Source checked | Concerns noted |
|---|---|---|---|