Caninsulin Callback | MSD Animal Health HUB

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Please provide as much detail as possible to best allow our advisors to fully assess your patient’s case. We regret we are unable to accept clinical histories and ask these are not returned with the call-back forms.

*fields are mandatory

Is this a new case or a follow up for a case previously discussed with MSD Animal Health? *

New diabetic case discussion

MSD Animal Health case number (if known):

Practice Name: *

Practice Postcode *

Vet’s/Nurse’s Name: *

Practice Telephone Number: *

Mobile Number:

Preferred contact day and time (AM or PM): *

Pet’s Name / Patient ID Number: *

Surname / Client ID number *

Species *

Dog

Cat

Breed: *

Sex *

Age: *

Weight: *

Current Body Condition Score: *

Diet: *

Diagnosis

Date diabetes diagnosed *

Presenting clinical signs *

Clinical examination findings *

Relevant results of initial investigations e.g. bloods, urinalysis, blood tests *

Please attach any further relevant documents including glucose curves, relevant diagnostic results, or correspondence.*

Relevant results of initial investigations e.g. bloods, urinalysis, blood tests *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Relevant results of initial investigations e.g. bloods, urinalysis, blood tests

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Relevant results of initial investigations e.g. bloods, urinalysis, blood tests

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Relevant results of initial investigations e.g. bloods, urinalysis, blood tests

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Relevant results of initial investigations e.g. bloods, urinalysis, blood tests

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Starting dose of Caninsulin, SID/BID? *

Subsequent Visits

Please provide a summary of the clinical history from diagnosis including any changes in clinical signs, dose changes, glucose curves, fructosamine results along with corresponding dates. Please do not attach a full clinical history. *

Please attach any further relevant documents including glucose curves, relevant diagnostic results, or correspondence.*

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Current status

Water intake *

Urination *

Appetite *

Demeanour *

Specific questions on this case

Please provide details of any specific questions you have about this case

Additional Information

Is your client using Caninsulin syringes or Caninsulin VetPen^®? *

Please provide details of any known comorbidities, current medications and if these are well controlled? *

Update on a case already discussed with MSD Animal Health

MSD Animal Health case number (if known):

Practice Name: *

Practice Postcode *

Vet’s/Nurse’s Name: *

Practice Telephone Number: *

Mobile Number if available:

Pet’s Name / Patient ID Number: *

Surname / Client ID number *

Species *

Dog

Cat

Breed: *

Sex: *

Age: *

Update of clinical case

Please provide a summary of changes since last discussion *

Please provide detail of current concerns about this case *

Current dose of Caninsulin *

Is your client using Caninsulin syringes or Caninsulin VetPen^®? *

Patient’s current weight and Body Condition Score *

Clinical signs compared to normal expectations

Water intake *

Urination *

Appetite *

Demeanour *

Please provide details of any diagnostics undertaken since last discussion including glucose curves or fructosamine results. Please do not attach a full clinical history. *

Please attach any further relevant documents including glucose curves, relevant diagnostic results, or correspondence.*

Please provide details of any diagnostics undertaken since last discussion including glucose curves or fructosamine results. Please do not attach a full clinical history. *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Please provide details of any diagnostics undertaken since last discussion including glucose curves or fructosamine results. Please do not attach a full clinical history.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Please provide details of any diagnostics undertaken since last discussion including glucose curves or fructosamine results. Please do not attach a full clinical history.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Please provide details of any diagnostics undertaken since last discussion including glucose curves or fructosamine results. Please do not attach a full clinical history.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Please provide details of any diagnostics undertaken since last discussion including glucose curves or fructosamine results. Please do not attach a full clinical history.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx.

Caninsulin^® 40 iu/ml Suspension for Injection contains an aqueous suspension of insulin containing 40 i.u. highly purified porcine insulin, which is structurally identical to canine insulin. POM-V.

If you are reporting a suspected adverse event please complete the form on our website https://www.msd-animal-health-hub.co.uk/PVForm.

MSD AH Privacy Notice:
MSD Animal Health UK Ltd., a division of Merck & Co, Inc., Rahway, NJ, USA (“MSD AH”), is committed to protecting your personally identifiable information in accordance with the applicable data protection laws. Our privacy notice is used to inform you about the information we collect, how we use it and who we share it with. The personal information (practice details and vet/nurse name) you have provided within the request form will be processed for the purpose of entering you into the MSD Animal Health UK Ltd (MSDAH) veterinary database and providing support for a diabetic pet/s described in the form. By providing your details, you consent to the processing by MSDAH, acting as data controller. Consistent with the purposes described above, you acknowledge that the Personal Information you provide to MSDAH can be transferred to Merck & Co., Inc. (Rahway, NJ, USA), which operates as MSD outside of the U.S. and Canada; its subsidiaries and/or, its subsidiaries and/or to companies globally that provide services on our behalf, if that is required, and in accordance with applicable laws and our instructions. This may include international transfers in compliance with the Data Protection Act 2018 and General Data Protection Regulation 2018, Binding Corporate Rules and Standard Contractual Clauses. Any party handling information on behalf of MSD is contractually obliged to process your personal information in accordance with the same privacy standards as MSD. Retention period applied will be ten years. You have certain rights to your personal information such as obtaining copies, correcting it or you can ask for it to be deleted. If you choose to exercise your data protection rights you can submit a request using the following link https://dsr.msd.com/DSR/United_Kingdom/English/ in your browser where you are able to request access, correct or delete your personal information. If you have questions or concerns about our use of your personal information, please contact us at the following email address: msdukdpo@msd.com where our privacy team can help you. You also have the right to contact the UK Information Commissioners Office. If you feel that we have not addressed your concern. For more information on our privacy practices and policies, please check our privacy commitments: https://www.msdprivacy.com/uk/en/.

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