::..Provincial Drug Control Unit Punjab..::

Name of the Complainent / Reporting Person :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Contact Number :

You must supply a value.

####-####### - Please enter a valid phone number.

Address

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Patient Name :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Age (in years) :

You must supply a value.

The value must be greater then or equal to 1.

The value must be less then or equal to 150.

Not a valid number.

Weight of Patient in Kilograms :

The value must be greater then or equal to zero.

The value must be less then or equal to 178.

Not a valid number.

Patient Contact Number :

You must supply a value.

####-####### - Please enter a valid phone number.

Patient Address :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Physician Name :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Physician Contact Number :

You must supply a value.

####-####### - Please enter a valid phone number.

Physician Address :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Medicine or Device Name :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Manufacturer :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Batch No :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Other :

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Medicine or Device Name 2:

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Manufacturer 2:

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Batch No 2:

You must supply a value.

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Other 2:

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Date of occurrence of problem :

You must supply a value.

Date of starting medicine :

You must supply a value.

Nature and the Details of the Complaint/Problem :

You must supply a value.

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Laboratory Findings (If Any):

You must supply a value.

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Seriousness of the event:

Value required.

Other Seriousness

Other Seriousness:

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Outcomes of the problem:

Fatal

Discontinued

Recovering

Not Known

Addiction:

Value required.

Other Addiction

Other Addiction:

You must supply a value.

Don't use the long version silly...we don't need to be that specific...

Current Disease:

You must supply a value.

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Medical History:

You must supply a value.

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Known Alergies:

You must supply a value.

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Medication History:

You must supply a value.

Don't use the long version silly...we don't need to be that specific...