SUSPECTED ADVERSE DRUG REACTION REPORTING FORM

Ph: 9474235064 /9850889891 | Email: adr@aniims.org

For VOLUNTARY reporting of Adverse Drug Reactions by healthcare professionals

Patient ID:
INDIAN PHARMACOPOEIA COMMISSION
(National Coordination Center - Pharmacovigilance programe of India)
Ministry of health & Family Welfare Government of India Sector-23, Rai Nagar, Gaziabad-201002
(AMC/ NCC Use only)
AMC Report No:
Worldwide Unique ID:

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