Complaints regarding medications/ consumables
Please use this form to inform the Drug Committee regarding your issues, complaints.
Select an option from the following *
Item name (If medication:Tradename AND generic name ) *
Please include the tradename and generic name or the item name of the consumable e.g. Anawin (Heavy bupivacaine for spinal) or Terumo 10cc syring etc.
Your answer
Batch number *
Your answer
Lot number *
Your answer
Expiry Date
Your answer
What is the complaint regarding? *
Select one or more options
Your answer
Brief description of the complaint
Please add a description
Your answer
Information of informer
This will help us get back to you for further information or to inform you of the progress we have taken so far.
Anonymous complaints will not be considered.
Your personal details will not be exposed to a third party.
Your name *
Pelase enter your name so that we can get in touch with you for further details or inform you regarding the progress of actions of the Equipment Committee. Your name will not be exposed to a third party.
Your answer
Your email. *
Your answer
Phone number (optional)
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy