Get Medicines Side Effect Reporting Form (for Consumers)

This guide provides clear and supportive instructions for filling out the Medicines Side Effect Reporting Form online. By following these steps, you will ensure that your reporting process is efficient and thorough.

Follow the steps to complete the form accurately and effectively.

1. Press the ‘Get Form’ button to access the reporting form and open it in your preferred online editor.
2. In Section 1, enter patient details. Provide the initials of the patient by writing the first letter of their first name and the first letter of their last name. Indicate the patient's gender and age.
3. In Section 2, provide health information. Include the reason(s) for taking the medicine, as well as who advised its use (e.g., doctor or pharmacist).
4. In Section 3, fill in the details of the person reporting the side effect. Include their name (optional), address, telephone number, and email.
5. In Section 4, provide details of the medicine taken. Include the name, quantity, expiry date, start date, and stop date of the medicine. Specify the dosage form (tablet, capsule, etc.).
6. In Section 5, state when the side effect started and whether it is still continuing. Include the date when the side effect stopped, if applicable.
7. In Section 6, evaluate how bad the side effect was by ticking the boxes that apply, indicating whether it affected daily activities, required hospitalization, or resulted in any other significant impact.
8. In Section 7, describe the side effect and any actions taken to manage it. Provide as much detail as possible to help in the assessment.
9. After completing the form, save your changes. You may then download, print, or share the form as needed.

Start filling out your report online to contribute to safer medicine use.