Drug Information Response

Who asked the drug information question?

Please list any contact information available from the requester (i.e.: address, phone number, e-mail, etc).

Who answered the drug information question?

Pharmacist

Student Intern

Pharmacy Technician

Other

When was the question received?

How was the question received?

Telephone/Mobile

In person

E-mail

Other

In what way would the requester like the response obtained?

Telephone/Mobile

Fax

E-mail

Other

What is the expected time to return this inquiry?

How long did it take to respond to the inquiry?

Please state the drug information question.

Please state your response to the inquiry.