Republic of Botswana - Admin

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*The patient’s identity is held in strict confidence and protected to the fullest extent. Program staff is not expected to & will not disclose the reporter’s identity in response to a request from the public. Submission of a report does not constitute an admission that medical personnel or manufacturer or the product caused or contributed to the event. 22
IV. CLINICIAN INFORMATION (If not the reporter): (to be confidential & used only for data verification, completion & case follow-up) Name & Professional Address : Telephone No (with Country code): Specialty: Date of Report: V. REPORTER: Name & Professional Address : Telephone No. (with Country code): Date of Report: Health professional: Yes No Occupation: Also Reported To: No one else Manufacturer Distributor Facility used Notification Through (Post, Facsimile, Electronic Device, etc.): Signature: Date: 23
Page 1 and 2: Guideline should be made available
Page 3 and 4: I. INTRODUCTION: Since drugs are in
Page 5 and 6: 8. Consumer: A person who is not a
Page 7 and 8: The use of herbal medicines which m
Page 9 and 10: Healthcare professionals need to le
Page 11 and 12: Pharmacovigilance and poison contro
Page 13 and 14: Local Reports: • Fatal or life-th
Page 15 and 16: Information about the patient’s i
Page 17 and 18: developed by training the staff by
Page 19 and 20: Promote reporting Collect report Gi
Page 21: Department of Clinical Services & T
Page 25 and 26: Latin Terms and Abbreviations TIME
Page 27 and 28: IV. Correlated Time 1 Ante cibos, a
Page 29 and 30: GLOSSARY: A drug or medicine is “

Republic of Botswana - Admin

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