Drug Information Center Gujarat State Pharmacy Council - Drug Information Request Form
DIC ADDRESS :
Drug Information Center, Gujarat State Pharmacy Council, Old Nursing College Building,Block No. – 4/A, 3rd Floor, Opp. Cancer Hospital, Gate No. – 6, Asarwa, Ahmedabad – 380016.
Contact us at :
(079) 2268 1014 or dic.gspc.nic@gmail.com
Disclaimer :
The drug information center is available to help you with your drug related queries. We can answer your queries from Monday to Friday 11:00 am to 5: 00 pm. Use the below request form for non urgent inquiries related to drugs. Your inquiries will be directed to licensed health care providers who will provide information with appropriate authenticity only. Information/answers/data provided to you as a service by DIC can be used as supplementary information which will be followed/ used at user’s own risk, DIC do not take any responsibility for any outcomes.
Enquirer’s Detail :
Name : *
Your answer
Address : *
Your answer
Gender : *
Contact Number : *
Your answer
Email ID : *
Your answer
Occupation :
Patient's Details :
Name :
Your answer
Address :
Your answer
Gender :
Age :
Your answer
Weight :
Your answer
Medical History/ Lab Result :
Your answer
Diagnosis/Disease state :
Your answer
Current Medication (If any) :
Your answer
Specific Conditions (Pregnancy/ Lactation/ Liver/ Renal failure/Allergies) :
Your answer
Type of enquiry :
Detailed/Description of Enquiry :
Your answer
Select the priority of the request based on situation :
Preferred Method of Response :
Note: Please furnish other information that you feel may be helpful in answering the drug informationqueries.
DIC-Gujarat State Pharmacy Council
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