Non Available Drug

Application for informing DGPADC about a drug non-availability

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Submission Date

Reporter civil id (Required)

Contact Person Name (Required)

Contact Person Phone (Required)

Contact Person eMail

Are you a Healthcare Professional? No Yes

Workplace (name of Hospital or Clinic) (Required)

Workplace (name of Hospital or Clinic)

Drug details

Type of drug Essential Emergency Life Saving

Product Name (Required)

Generic name

Manufacturer

Local agent

Dosage form (Required) TABLETS LIQUID POWDER CAPSULES ORAL SUSPENSION VAGINAL OVULE ORAL DROPS INTRAUTERINE SYSTEM OINTMENT CREAM INJECTION Paste Oral Granules TOPICAL SOLUTION NASAL GEL NASAL SPRAY NEBULISER PATCH GEL SOLUTION FOR NEBULIZATION MOUTH WASH AEROSOL SPRAY SHAMPOO RECTAL SUPPOSITORY VAGINAL CREAM OPHTHALMIC SOLUTION VAGINAL RING OPHTHALMIC CREAM EAR DROPS SPRAY SOLUTION BAR SOAP VAGI.DOUCHE POWDER VAGINAL GEL LYOPHILIZED POWDER FOR SOLUTION FOR (IV) INJECTION AND INFUSION SOLUTION FOR PERITONEAL DIALYSIS PREFILLED AUTHINJECTOR Rectal Tube Orabase or Oral ointment Oral Solution Elixir Evohaler Inhaler Patch Suppository Water for irrigation Ophthalmic Strips Ophthalmic Ointment Enema Water for injection POWDER FOR SOLUTION FOR INJECTION Lotion

Strength (Required)

Strength Unit mg/Ml mg/Vial Iu mg mG/ML mG/HR mG/GM mG/Vial mG % mg+mg µl/Dose µl %w/w %w/r gm Mcg/gm Gm/ml iu/ml mg/gm Gm/Vial µl/Vial Mg mg+mg µu/Vial Mg/ML mcg mcg/hr mcg/vial mcg/2ml mcg/0.5ml pg mcg/gm mcg / g + 0.5 mg /g mg / 2 ml mg / 3 ml mg / g + 1 mg /g VALENT pH ml DOSE/VIAL mcg/ml mg/5ml %w/v Test

Quantity required (Required)

Remarks

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