Digicon

@if (isset(session()->get('doctor')['vCentralCode']))

Back

@else

@endif

@if(isset(session()->get('doctor')['vCentralCode']))

Name *

@else

Name *

@endif

ID No. *

Initials *

Age(in Years) *

Weight(in KG)*

Gender *

Male Female

COPD

Acute exacerbation of COPD

chronic bronchitis

Other indication (please mention)

RTCLEAR (Acebrophylline 100 mg+N-acetylcysteine 600 mg)

Other (mention the dose)

Duration of treatment:

5 Days 7 Days 10 Days 14 Days

Physician’s assessment:

Clinical improvement *

Yes No

Clinical failure **

Yes No

* Clinical improvement defined as patient who retained evidence of infection but demonstrated a reduction of the majority of the clinical signs and symptoms of infection and no new or worsened signs associated with the original infection
** Clinical failure defined as any of the following i) persistence or progression of signs and symptoms of infection ii) development of new clinical findings consistent with active infection iii) Death from infection

Adverse Event *

Yes No

{{ $ActivityTypeName }}

Patient {{ $iPatientNo }}

Doctor’s Details

Patient’s Details

Diagnosis

Treatment:

Physician’s assessment:

CLINICAL SAFETY ASSESSMENT

Adverse Events