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Republic of Botswana - Admin

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For <strong>of</strong>fice use only:<br />

Received on……………………. Registration No……………. Received by…………………..<br />

* Specialist reporting can be a Pharmacist, Nurse, Dentist, Pathologist, Medical Practioner, Health care worker,<br />

Midwives, etc. Others include Pharmaceutical industries, Volunteers, etc.<br />

* Key:<br />

M/F = Male/Female, D/M/Y = Date/Month/Year, N/A = Not Available<br />

* What to report:<br />

All suspected reactions to drugs<br />

Unknown or unexpected ADRs<br />

Serious adverse drug reactions<br />

Unexpected therapeutic effects<br />

All suspected drug interactions<br />

Send the Form to:<br />

Drug Regulatory Unit<br />

Ministry <strong>of</strong> Health<br />

P/Bag 0038, Gaborone<br />

<strong>Botswana</strong><br />

Tel: +267- 3632383<br />

Fax: +267- 3170169<br />

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