For patients

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For the patient and/or patient representative

    1. General information
    2. Information about the suspected medicine
    3. Information on the purpose of the suspected medicine
    The suspected medicine was prescribed to the patient by a doctor
    The patient used a suspected medicine without a doctor’s prescription
    4. Description of manifestations of an adverse reaction and/or indications of lack of effectiveness of the medicine
    5. Information about the notifier
    6. Information about the doctor and health care where the attending physician works