Text Size: A+| A-| A   |   Text Only Site   |   Accessibility
Retail Pharmacy Reporting
Submit a Report
Report Form
Click "Pharmacy Report Form" to the right to access the adverse event reporting form for retail pharmacies.  Choose the correct harm level to display all required fields.
 
Note: File may take a few seconds to load.

Report Form

Pharmacy Report Form
 
Page updated: December 04, 2008

Click here to go to the Oregon Dept. of Veterans' Affairs outreach contact form

Get Adobe Acrobat ReaderAdobe Reader is required to view PDF files. Click the "Get Adobe Reader" image to get a free download of the reader from Adobe.