ZFDA - Pharmaco Web Portal

proDescription

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

reporterHeading

fullName *

email *

phone *

island *

region *

district *

ward *

street *

# facilityHeading

island *

patientHeading

fullName *

dob (optional)

dobType (optional)

gender *

weight (optional)

height (optional)

island *

region *

district *

ward *

street *

# otherInformation

allergy (ifAny)

medicalHistory (ifAny)

suspectHeading

startDate *

stopDate (optional)

latency *

duration

Reaction

medicineHeading

medicineType *

medicine *

batch (optional)

expire (optional)

source *

dose (optional)

frequency *

route *

startDate *

stopDate (optional)

reason *

#	name	batch	expire	source	dose	frequency	route	startDate	reason
noContent

herbalHeading

Have you ever used herbal medicine during the reaction ?

no yes

LaboratoryHeading

#	test	startDate	complainType	creator
noContent