record adverse effects – paitent – Zistdaru

Record side effects

Record side effects

Contact number of Tehran office nurses

09352203041
09352203042
09352203043

Contact number of the nursing office

021-88520399
021-88179165
021-88520397

Nursing Email

nursing@zistdaru.ir

Name

Last Name

Name of the Medicine

Phone Number

Description of side effect

History of concurrent diseases

History of concurrent medicines

Duration of side effect

City/Hospital

History of sensitivity to any food or medicine

Doctor

Other Details