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rxcounciljm@pcoj.gov.jm | thepcoj@gmail.com
(876) 926-2637 / (876) 926-4353 / (876) 902-2807

Government of Jamaica

Government of Jamaica

The
Pharmacy
Council

91 Dumbarton Avenue
Kingston 10, Jamaica
Mon - Thur 8:30am - 5:00pm
Fri 8:30am - 4:00pm

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Drug Monitoring

A) Patient Details

First Name *

Last Name

Gender *MF

Date of Birth *

Ethnicity *

Weight *

Height *

B) Suspected Drug Event

Outcomes attributed to use of drug (check all that apply): *Failure of therapyDisabilityHospitalisationAllergyLife threateningDeathOther

Date of Death *

Describe *

Describe event or problem *

Date event started *

Date event ended *

Describe action taken in response (e.g., drug changed, prolonged-therapy, increased dose)

Describe other relevant history including abnormal laboratory test results, days of hospitalization.

C) Drug Information

Name of suspected drug (give specific name on package) *

Dose & Route *

Indication *

Batch number if known *

Name of other drugs taken (give specific name on package)

Dose & Route

Indication

Batch number if known

D) Reporting Health Professional Information

Profession *

Name *

Address *

Phone *

Fax

Email Address *

Also reported to

Signature *

Start signing your signature here

The
Pharmacy
Council

The Pharmacy Council has the responsibility for the regulation of pharmacists, pharmaceutical students and pharmacy owners in Jamaica.

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Adverse Drug Reporting

About
Contact
Forms
Approved Preceptors
Approved Institutions
Registration Appeals
Adverse Drug Reporting

Ministry of Health & Wellness
Ministry of Justice
The Pharmaceutical Society of Jamaica
The Companies Office of Jamaica
The Registrar General’s Department
Pesticides Control Authority
Privacy Policy

Ministry of Health & Wellness
Ministry of Justice
The Pharmaceutical Society of Jamaica
The Companies Office of Jamaica
The Registrar General’s Department
Pesticides Control Authority
Privacy Policy

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