Get Adr Reporting Form

This guide provides essential information on how to accurately complete the Adr Reporting Form. By following these steps, users can ensure that they provide all necessary details required for reporting suspected adverse drug reactions.

Follow the steps to accurately complete the Adr Reporting Form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling in section A, Patient Information. Provide the patient's initials, age at the time of the event, gender, and weight. Make sure all information is accurate to assist in identifying the patient’s case effectively.
3. In section B, Suspected Adverse Reaction, enter the date the reaction started and, if applicable, the date of recovery. Clearly describe the reaction or problem experienced by the patient.
4. Continue with section B, indicating the seriousness of the reaction. Select the appropriate options that classify the reaction’s severity, such as whether it resulted in hospitalization or was life-threatening.
5. In section C, provide details about the suspected medication(s). Enter the name of the medication, its batch number if known, the expiration date, dosage, route, frequency, and therapy dates. Be thorough, as this information is crucial for evaluating the adverse reaction.
6. Answer the questions regarding the reaction's disappearance after stopping or reducing the medication and if the reaction reappeared after reintroduction.
7. Provide information on any concomitant medical products used. Include self-medication and herbal remedies along with their respective therapy dates, excluding those used to treat the reaction.
8. In section D, Reporter Information, enter your name, professional address, pin code, telephone number, occupation, and email. This information is essential for following up on the report if necessary.
9. Finally, review your form for accuracy, sign it, and enter the date of the report before submitting. Once completed, you can save changes, download, print, or share the form as needed.

Ensure that you complete the Adr Reporting Form online to contribute to the safety and well-being of all patients.