Confidentiality and Data Protection
We assure you that all personal information provided will be treated with the highest level of confidentiality and used solely for pharmacovigilance purposes.
2
ADVERSE DRUG REACTION (ADR)
3
SUSPECTED SWIPHA DRUG
(Including Biologicals Medicines & Nutraceuticals)
DRUG DETAILS
(State name and other details if available / Attach product label / Sample (if available)
4
CONCOMITANT MEDICINES
(All medicines taken within the last 3 months including Nutraceutical and self-medication)