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The Official Website of
Drug Information Centre (Chhattisgarh State Pharmacy Council)
DRUG INFORMATION REQUEST FORM
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Fields are Compulsory
Date
Wednesday, February 8, 2023
Time
1:58:57 PM
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Name of Enquirer
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Phone No.
Mail ID
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Address
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Background/Qualification
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The Enquirer's professional status
Physician
Surgeon
Resident
PG's
Interns
Nurse
Pharmacist
Community
Hospital
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Others
Patient
Public
Mode of Request
Direct Access
During Ward Rounds
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Query from
India
Abroad
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Details of Enquiry
Purpose of Enquiry
Update Knowledge
Better Patient Care
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Answer needed
Immediately
With 30 minutes
> 1 Hour
More than a day
Patient Details
Age
Weight
Sex
Male
Female
Liver/ Renal Functions
Allergies
Current Medical Problems
Relevant Drug Therapy
Other Details
If Pragnent
First Trimester
Second Trimester
Third Trimester
If Breast Feeding
Age of the Infant
months