Accu-Chek Spirit 3.15 ml cartridge system Manufacturer’s reference: SB_RDC_2024_05 SRN number: DE-MF-000006276 In November, Roche Diabetes Care reached out regarding a Field Safety Notice because our records indicate that your hospital has purchased the Accu-Chek Combo insulin pump. Please acknowledge this Field Safety Notice using the form below. To ensure our records are correct, we kindly request that that you also provide us with the contact details for the person responsible for safety communications. If known, please add your Accu-Chek Reference below (starts with ACC). Reference Please indicate the number of patients currently funded using the Accu-Chek pump (if available) Number of Accu-Chek Combo users funded Form completed by First name Last name Position/Job Title Professional email address Professional contact number Hospital Eircode Address Safety contact details (if different) First name Last name Position/Job Title Professional email address Professional contact number Hospital Eircode I confirm to have received, read and understood the information in this Field Safety Notice. Roche Diagnostics Limited will process your data to record your acknowledgement against your unique customer ID. You can find out more about how we use your personal data by reading our Accu-Chek privacy notice. Exclude from search results No
