1. ERA LUCKNOW MEDICAL COLLEGE AND HOSPITAL , ERA
UNIVERSITY,SARFRAZGANJ,LUCKNOW 226003
DEPARTMENT OF NURSING
DAILY ADR REPORTING STATUS BY ALL WARDS:
S.NO NAME OF THE
WARD
Adverse Drug
reaction status
Sign
/symptom of
ADR
Correctiv
e action
Prevent
ive
action
Remarks
/incharge
sign
1. MOW
2. FOW
3. PVT.W
4. PEDIAI
5. PEDIA II
6. PEDIA III
7. GYNEC.W
8. OBS.I
9. OBS.W II
10. TBC .W
11. Isolation(TBC)
12. Blood Bank
13. MMW-I
14. MMWII
15. FMW-I
16. FMWII
17. MSW I
18. MSW II
19. MSW III
20. FSW-I
21. FSWII
22. PSY.W
23. ENT .W
24. EYE.W
25. Isolation
26. Wellness
27. SKIN.W
28. BURN.W
29. PEDIA.SUR.W
30. Radiology
31. Immunization
Clinic
32. Endoscopy
33. Bronchoscopy

2. Report By Nursing Supervisor :
Reporting To Medical Supt :
Corrective And Preventice Action Taken
By Pharmacy/Theraputic Committee:
PREPARED BY
K.L.MIRZA (ANS)ELMCH

3. ERA LUCKNOW MEDICAL COLLEGE AND HOSPITAL , ERA
UNIVERSITY,SARFRAZGANJ,LUCKNOW 226003
DEPARTMENT OF NURSING
DAILY ADR REPORTING STATUS BY ALL CRITICAL CARE AREA .:
S.No Name Of
The Ward
Adverse
Drug
reaction
status
Sign
/symptom
of ADR
Corrective
action
Preventive
action
Remarks
/supervisor
/incharge sign
1. ICCU I
2. ICCU-II
3. ICU I
4. HDU I
5. HDUII
6. NICU
7. PICU
8. SICU
9. CTVS
10. LR
11. EMR
12. POST-OP
13. PRE-OP
Report By Nursing Supervisor :
Reporting To Medical Supt :
Corrective And Preventice Action Taken
By Pharmacy/Theraputic Committee:
PREPARED BY
K.L.MIRZA (ANS)ELMCH

4. Guided by
Dr.Anjalatchi Muthukumaran
Nursing Superintendent , ELMCH