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Get 03 Erivedge Hcp Pregnancy Reporting Form 18082016.doc
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How to fill out the 03 Erivedge HCP Pregnancy Reporting Form 18082016.doc online
This guide provides a detailed overview of filling out the 03 Erivedge HCP Pregnancy Reporting Form online. It covers all necessary sections and fields within the form to ensure your reporting is thorough and accurate.
Follow the steps to complete the form effectively.
- Press the ‘Get Form’ button to access the form and open it in the online editor.
- Begin by filling in the 'Reporter Information' section. Provide your name, role (e.g., physician or pharmacist), contact address, telephone number, and email. Ensure all contact details are correct for follow-up purposes.
- In the 'Exposed Parent's Details' section, indicate who was exposed (mother or father) and fill in their initials, date of birth, height, weight, age at conception, and ethnic origin.
- For 'Product Information,' specify the product name and related details. Document the time of exposure, trimester, and any medications taken prior to and during pregnancy.
- Complete the 'Pregnancy Information' section, including key dates such as the last menstrual period, conception date, and estimated delivery date.
- Fill out the 'Medical History' section, detailing previous pregnancies, contraception methods used, any risk factors, and other relevant medical history.
- Provide details of the 'Pregnancy Outcome,' indicating whether the pregnancy was ongoing, resulted in a live birth, or ended in other outcomes. Include relevant dates.
- Document any 'Relevant Laboratory Tests/Procedures' that were conducted pre and post outcome, including the results if available.
- Complete the 'Birth Outcome' section, providing information on the infant/fetal outcome, including weight, length, gestational age, and Apgar scores.
- Fill in the 'Relevant Laboratory Tests/Procedures for Baby/Fetus' if applicable, providing results as needed.
- Finally, review the 'Additional Information' section. Sign and date the form, making sure to provide your contact information if you require follow-up.
- Once completed, you can save your changes, download, print, or share the form as necessary.
Complete the 03 Erivedge HCP Pregnancy Reporting Form online today.
Erivedge can have an impact on the immune system, potentially leading to increased susceptibility to infections. It's crucial to monitor your health closely while on this medication and communicate any concerns with your healthcare provider. Proper management is key, and the 03 Erivedge HCP Pregnancy Reporting Form 18082016.doc can assist in understanding the implications.
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