Get Suspected Adverse Drug Reaction Reporting Form - Indian ... - Ipc Nic

Filling out the Suspected Adverse Drug Reaction Reporting Form is essential for healthcare professionals wishing to report adverse drug reactions accurately. This guide provides a step-by-step approach to ensure the process is efficient and clear for all users.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the reporting form and open it in your preferred editor.
2. In section A, enter the patient's initials in the designated field. Make sure this information is clear and accurate.
3. Indicate the age of the patient at the time of the event or their date of birth in the appropriate space.
4. Select the gender of the patient by marking the relevant box for Male, Female, or Other.
5. Provide the patient's weight in kilograms to help assess the reaction.
6. Fill in section B regarding the suspected adverse reaction. Record the date the reaction started and, if applicable, the date of recovery.
7. Describe the reaction or problem experienced by the patient clearly in the relevant field.
8. Indicate the seriousness of the reaction by selecting the appropriate options. Provide details such as if hospitalization occurred or if the reaction was life-threatening.
9. In section C, list the suspected medication(s) including their name, manufacturer, batch number, expiration date, and the dose used.
10. Detail the therapy dates, frequency of administration, and the indication for use of the medications.
11. Document any action taken in response to the adverse reaction, indicating if the drug was withdrawn, the dose was changed, or other relevant actions.
12. List any concomitant medications along with their administration details, excluding those used to treat the reaction.
13. Complete section D by providing your name, professional address, email, phone number, occupation, and signature.
14. Finally, enter the date of this report before submitting.
15. Once you have filled out all necessary fields, review the form for accuracy, save your changes, and proceed to download, print, or share the form as needed.

Take the next step in ensuring drug safety by completing your Suspected Adverse Drug Reaction Reporting Form online today.