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Get Adverse Drug Reaction Reporting Form

Ntiality of adverse reaction information Any information related to the identity of the patient and/or the reporter of the AR is kept strictly confidential. For the identifier box, provide some type of identifier that will allow you, the reporter, to readily locate the case if you are contacted for more information; do not use the patient s name. Privacy Notice Statement: Individuals have access to and protection of any provided personal information under the provisions of the Access to.

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