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Rol Organization Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, FDA Bhavan, ITO, Kotla Road, New Delhi -110002 www.cdsco.nic.in Worldwide Unique no. A. Patient information 1. Patient initials 12. Relevant tests/ laboratory data with dates 2. Age at time of Event or date of birth 3. Sex: M F 4.Weight: Kgs B. Suspected Adverse Reaction 13. Other relevant history, including pre-existing medical conditions (e.g., allergies, race, pre.

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Healthcare professionals including doctors, Chinese medicine practitioners, dentists, pharmacists and nurses are encouraged to report suspected adverse drug reaction of their patients voluntarily.

It's quick and easy to report You can also report suspected adverse reactions to medicines: via the free Yellow Card app; download now from the Apple App Store or Google Play Store. through some clinical IT systems (SystmOne/Vision/MiDatabank) by phone: 0800 731 6789 (freephone number, 10am to 2pm Monday-Friday)

Suspected ADRs to any therapeutic agent should be reported, including drugs (self- medication as well as those prescribed), blood products, vaccines, radiographic contrast media, complementary and herbal products.

You can usually report side effects by filling in a form online or from your doctor or local pharmacy. For more details, and to report online, please check the website of your national authority (use these links to ensure you are reporting to the appropriate website).

Patient Information: Initials, age at onset of reaction. Suspected Adverse Reaction: Description of the reaction (reaction terms), reaction date. Suspected Medication(s): Name (brand/generic) of the medication. Reporter Details: Name, address, contact details, qualification, and date of the report.

All health care providers including specialists, doctors, dentists, pharmacists and nurses can report ADRs and AEFIs. All affected consumers are encouraged to report ADRs directly to their healthcare professionals and zonal Drug Information centers.

Patient Information: Initials, age at onset of reaction. Suspected Adverse Reaction: Description of the reaction (reaction terms), reaction date. Suspected Medication(s): Name (brand/generic) of the medication. Reporter Details: Name, address, contact details, qualification, and date of the report.

ADR reporting is an important aspect of an efficient and effective pharmacovigilance program. Although Medwatch, Yellow Card, CDSCO form, etc. are the protocol forms of ADR collection and reports, a number of countries design and use their respective ADR forms.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232