Important Forms

HTAR Pharmacy Department

• Jadual Oncall Requests 

Adverse Drug Reactions and Allergy

• Adverse Drug Reaction (ADR) / Adverse Event Following Immunisation (AEFI) Reporting: Manual for Healthcare Providers, 2021

• Guide for ADR Reports, 2022

• Report on Suspected Adverse Drug Reactions

• Clinical Manifestation of Adverse Drug Reaction

• Glossary and Pictures of Clinical Manifestation of Cutaneous Adverse Drug Reaction 

• Borang Pemantauan Kesan Advers Ringan Susulan Imunisasi, 2024

Allergy

• Garis Panduan Pengurusan Maklumat Alahan Ubat Pesakit, 2025

• Borang Permohonan Kad Alahan, 2025

Medication Errors

• Medication Error Reporting System 

• Medication Error (ME) Reporting Form

• Incident Reporting Form ( Fill in Together with ME Form)

Ubat Kelulusan Khas (UKK)

• Garis Panduan Permohonan Ubat Keluluan Khas, 2024

• Pengecualian Ubat Kelulusan Khas (UKK / KPK)

• Pengecualian Ubat Kelulusan Khas (UKK/KPK) Rumusan

• UKK/ KPK - Patient Basis Form

• UKK/ KPK - Stock Basis Form

• UKK/ KPK - Registered Drug Renewal Form (Only for Renewal Purposes)

• UKK/ KPK - Patient Monitoring Form (Fill In When Renewing Patient Basis KPK)

Hospital Formulary

• Tatacara Pengendalian Mesyuarat Jawatankuasa Ubat & Terapeutik di Fasiliti KKM, 2024 

• New Drug Form (Drugs Already Available in Hospital Formulary)

• Lampiran A - Permohonan Ubat Sampel

• Lampiran D - Application to Bring In Drug Into Hospital Formulary

• Lampiran F - Application to Remove Drug From Hospital Formulary

• Lampiran G - Increase Drug Quota

Miscellaneous

• Product Quality Complaint Form

• Consent Form (off Label) 

• Iron Dextran Calculation Sheet, 2019