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VIAGRA Connect Checklist

Optional support when assessing a man's suitability for VIAGRA Connect

Checklist

Although there is no mandatory requirement to use the Checklist, it is recommended that you use the Checklist questions as a framework to assess suitability. Always use your professional judgement when using the Checklist as an aid in deciding whether to supply VIAGRA Connect.

You may also wish to check the patient's Summary Care Record or Patient Medication Record to check their concomitant conditions, such as hepatic disease or renal impairment, and medication intake, such as nitrate use. 

If you consider a man to be suitable for supply, you can use the tear-off slip at the bottom of the Checklist then sign and date it before giving it to him. This can act as a reminder of the date he first received the product, as well as facilitating repeat supply – assuming no changes have occurred to his medication or underlying health. Remind him to follow up with his doctor within the first 6 months of use. For further information go to the Repeat Supply section. 

Men who do not receive the product should be given the reason for this and, if appropriate, advised to go to their doctor. If referring the man to his doctor, write this explanation on the tear-off slip at the bottom of the Checklist. The man can then take the slip to the doctor, to help start the conversation. For further information go to the Patient Referrals section.