Pharmaceutical report - Medical Association of Malta

Vis Unita Fortior

Representing Malta’s doctors since 1954

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Use this form to report medicine shortages, supply problems or other pharmaceutical issues affecting your practice.

DPA Report Form

POYC / Exceptional Treatment Feedback Form

Purpose: To document specific problems encountered by consultants or Senior Registrars when requesting or renewing drugs under POYC or Exceptional Treatment, so that these can be collated and presented to DPA and relevant stakeholders for system improvement.

Name and Surname

Gov CORP Email

Role / Grade

Speciality / Unit

Section 2: Case Details

Case Details ( Kindly provide as much information as possible )

Date of Issue Encountered

Type of Request:

Other

Drug Name:

Indication:

Urgency of Request:

Routine

Urgent

Time-Critical

Section 3: Nature of the Problem

Nature of Problem

What was the issue encountered? (Tick all that apply):

If Other chosen kindly provide more information :

Brief Description of What Happened:

Section 4: Suggestions (Optional)

Suggestions ( Optional )

Suggested Improvement or Workaround:

Section 5: Attachments (Optional)

Attachments (Optional)

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