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Services - Adverse Drug Reaction (ADR)
Drug-related adverse events represent an alarming problem that must be addressed by health care practitioners. Adverse drug reactions are responsible for a significant number of hospital admissions, with reported ranges from 0.3% to as high as 7%. Some have estimated that up to 15% of hospitalized patients suffer at least one adverse drug reaction during their hospital stays.

This prospective system benefit the patients who experience a reaction because they are recognized earlier and future patients benefit from information learned from past patients. Other benefits could include the economic Impact Of Reduced Hospitalization, Efficient And Economical Drug Use, and Minimized Organizational Liability.

Hence you are invited to participate in our ADR program and please fill in the following format conserning the ADR you have encountered for the benefit of others and the future.

Kindly fill the form and Submit
All Drug Therapy Prior to Reaction Suspected Drugs Daily Dosage and Route Begin Date Stopped Date Reason for use
Patient's Details :
Name or Record *      
Age : * Height : *  
Sex : * Male Female Weight : *  
Date of onset of
Reaction : *
Adverse Reaction Description *      
Treatment (of reaction) :
Outcome :        
Recovered : Date of Recovery :  
Not yet Recovered : Unknown :  
Fatal : Date of   Death :  
Sequelae : Yes No      
Comments (e.g. Relevant history, allergies, previous exposure to this drug)
Doctor / Pharmacist Information :
Name : *      
E-mail :*      
Security Code *      
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