Zakłady Farmaceutyczne 'UNIA'

Drug safety form

Drug name:

Contents:

Postal address, phone no., Fax or e mail address that has to be answered::

First name and last name:

Age:

I agree to share my personal data collected by the Pharmaceutical Plant "UNION" Poland in connection with the implementation of the monitoring of adverse events, entities belonging to the Pharmaceutical Plant "UNIA" in order to assess product safety. Please note that your / personal data will be processed by the Pharmaceutical Plant "UNION" Poland, based in Warsaw, ul. Cool 56/60, in accordance with the Act of August 29, 1997. On personal data protection (Dz. U. of 2002., No. 101, item. 926, as amended.) For the purposes of monitoring of adverse effects resulting from the Act art. 24 of the Act of 6 September 2001 Pharmaceutical Law (Dz. U. of 2008 No. 45, item. 271, as amended. D.) And for archival purposes. The collected data will be made available for the assessment of product safety entities belonging to the Pharmaceutical Plant "UNION". Every person has the right to access their data and correct them. Providing personal data is voluntary, but it is necessary to answer the Pharmaceutical Plant "UNION".
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Description of the drug is available only to qualified persons

Drug safety form