http://www.dgpml.sante.gov.bf/ fr SPIP - www.spip.net http://www.dgpml.sante.gov.bf/spip.php?article80 http://www.dgpml.sante.gov.bf/spip.php?article80 2010-09-07T14:42:01Z text/html fr dgpml Communiqués - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique17" rel="directory">Communiqués</a> <div class='rss_texte'><dl class='spip_document_152 spip_documents spip_documents_left' style='float:left;width:120px;'> <dt><a href="http://www.dgpml.sante.gov.bf/IMG/pdf/note.pdf" title='PDF - 331.9 ko' type="application/pdf"><img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L52xH52/pdf-d7486.png' width='52' height='52' alt='PDF - 331.9 ko' style='height:52px;width:52px;' class=' format_png' /></a></dt> </dl> <p class="spip">|Télécharger la note d'information du rapport synthétique publique des deux premières sessions de la commission technique d'enregistrement du médicament et autres produits pharmaceutiques (CTEM) de l'année |</p></div> http://www.dgpml.sante.gov.bf/spip.php?article114 http://www.dgpml.sante.gov.bf/spip.php?article114 2010-09-07T14:26:23Z text/html fr dgpml Communiqués - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique26" rel="directory">Communiqués</a> <div class='rss_texte'><dl class='spip_document_153 spip_documents spip_documents_left' style='float:left;width:120px;'> <dt><a href="http://www.dgpml.sante.gov.bf/IMG/pdf/note-2.pdf" title='PDF - 331.9 ko' type="application/pdf"><img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L52xH52/pdf-d7486.png' width='52' height='52' alt='PDF - 331.9 ko' style='height:52px;width:52px;' class=' format_png' /></a></dt> </dl> <p class="spip">|Télécharger la note d'information du rapport synthétique publique des deux premières sessions de la commission technique d'enregistrement du médicament et autres produits pharmaceutiques (CTEM) de l'année |</p></div> http://www.dgpml.sante.gov.bf/spip.php?article111 http://www.dgpml.sante.gov.bf/spip.php?article111 2010-02-16T16:14:15Z text/html fr dgpml Alertes - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique11" rel="directory">Alertes</a> http://www.dgpml.sante.gov.bf/spip.php?article108 http://www.dgpml.sante.gov.bf/spip.php?article108 2010-02-16T15:58:28Z text/html fr dgpml Communiqués - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique10" rel="directory">Communiqués</a> http://www.dgpml.sante.gov.bf/spip.php?article103 http://www.dgpml.sante.gov.bf/spip.php?article103 2010-02-16T11:39:22Z text/html fr dgpml Accueil - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique1" rel="directory">Accueil</a> http://www.dgpml.sante.gov.bf/spip.php?article102 http://www.dgpml.sante.gov.bf/spip.php?article102 2010-01-23T13:52:44Z text/html fr dgpml Préfaces - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique7" rel="directory">Préfaces</a> <div class='rss_texte'><a name='form1'></a> <div class='spip_forms form_1'> <div class='spip_descriptif'></div> <form method='post' action='spip.php?page=backend#form1' enctype='multipart/form-data'> <div> <input name='page' value='backend' type='hidden' /> <input type='hidden' name='ajout_reponse' value='1' /> <input type='hidden' name='id_donnee' value='0' /> <input type='hidden' name='retour_form' value='' /> </div> <div > <fieldset><legend>Fiche de notification des effets indésirables des médicaments</legend> <div class='spip_form_champ ligne_1'> <span class='spip_form_label'> <label for="input-1-ligne_1">Région sanitaire de</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_1' id='input-1-ligne_1' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_2'> <span class='spip_form_label'> <label for="input-1-ligne_2">District sanitaire de</label> : </span> <input type="text" name='ligne_2' id='input-1-ligne_2' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_3'> <span class='spip_form_label'> <label for="input-1-ligne_3">Formation Sanitaire</label> : </span> <input type="text" name='ligne_3' id='input-1-ligne_3' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_4'> <span class='spip_form_label'> <label for="input-1-ligne_4">Service</label> : </span> <input type="text" name='ligne_4' id='input-1-ligne_4' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_5'> <span class='spip_form_label'> <label for="input-1-ligne_5">Nom et Prénom</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_5' id='input-1-ligne_5' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_6'> <span class='spip_form_label'> <label for="input-1-ligne_6">Département</label> : </span> <input type="text" name='ligne_6' id='input-1-ligne_6' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_7'> <span class='spip_form_label'> <label for="input-1-ligne_7">V i l l e / C o m m u ne</label> : </span> <input type="text" name='ligne_7' id='input-1-ligne_7' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_8'> <span class='spip_form_label'> <label for="input-1-ligne_8">Village/Quartier/ Secteur</label> : </span> <input type="text" name='ligne_8' id='input-1-ligne_8' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_9'> <span class='spip_form_label'> <label for="input-1-ligne_9">Tél ou autre adresse :</label> <span class='spip_form_label_obligatoire'> [Obligatoire]</span> : </span> <input type="text" name='ligne_9' id='input-1-ligne_9' value="" class=' ligne forml' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_10'> <span class='spip_form_label'> <label for="input-1-ligne_10">Profession</label> : </span> <input type="text" name='ligne_10' id='input-1-ligne_10' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_11'> <span class='spip_form_label'> <label for="input-1-ligne_11">Date de naissance ou Age</label> : </span> <input type="text" name='ligne_11' id='input-1-ligne_11' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_1'> <span class='spip_form_label'> <span class='label'>Sexe</span> : </span> <input type='hidden' name='multiple_1[]' id='input-1-multiple_1' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_1[]' id='input-1-multiple_1_1' value='multiple_1_1' /> <label for='input-1-multiple_1_1'>Féminin</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_1[]' id='input-1-multiple_1_2' value='multiple_1_2' /> <label for='input-1-multiple_1_2'>Masculin</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_12'> <span class='spip_form_label'> <label for="input-1-ligne_12">Poids (kg)</label> : </span> <input type="text" name='ligne_12' id='input-1-ligne_12' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_13'> <span class='spip_form_label'> <label for="input-1-ligne_13">Taille (cm)</label> : </span> <input type="text" name='ligne_13' id='input-1-ligne_13' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_2'> <span class='spip_form_label'> <span class='label'>Grossesse</span> : </span> <input type='hidden' name='multiple_2[]' id='input-1-multiple_2' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_2[]' id='input-1-multiple_2_1' value='multiple_2_1' /> <label for='input-1-multiple_2_1'>Oui</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_2[]' id='input-1-multiple_2_2' value='multiple_2_2' /> <label for='input-1-multiple_2_2'>Non</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_1'> <span class='spip_form_label'> <label for="input-1-date_1">Date Dernières Règles</label> : </span> <input type="text" name='date_1' id='input-1-date_1' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_3'> <span class='spip_form_label'> <span class='label'>Trimestre de grossesse</span> : </span> <input type='hidden' name='multiple_3[]' id='input-1-multiple_3' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_3[]' id='input-1-multiple_3_1' value='multiple_3_1' /> <label for='input-1-multiple_3_1'>1er</label></li> <li> <input type='checkbox' name='multiple_3[]' id='input-1-multiple_3_2' value='multiple_3_2' /> <label for='input-1-multiple_3_2'>2ème</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_3[]' id='input-1-multiple_3_3' value='multiple_3_3' /> <label for='input-1-multiple_3_3'>3ème</label></li> </ul> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_1'><legend>MEDICAMENTS PRIS DURANT LA PERIIODE</legend> <div class='spip_form_champ ligne_14'> <span class='spip_form_label'> <label for="input-1-ligne_14">Désignation (Nom Commercial et/ou DCI, forme, dosage, présentation)</label> : </span> <input type="text" name='ligne_14' id='input-1-ligne_14' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_15'> <span class='spip_form_label'> <label for="input-1-ligne_15">N° de lot et date péremp.</label> : </span> <input type="text" name='ligne_15' id='input-1-ligne_15' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_16'> <span class='spip_form_label'> <label for="input-1-ligne_16">Lieu de délivrance</label> : </span> <input type="text" name='ligne_16' id='input-1-ligne_16' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_17'> <span class='spip_form_label'> <label for="input-1-ligne_17">Voie et site d'admin</label> : </span> <input type="text" name='ligne_17' id='input-1-ligne_17' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_19'> <span class='spip_form_label'> <label for="input-1-ligne_19">Posologie</label> : </span> <input type="text" name='ligne_19' id='input-1-ligne_19' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_2'> <span class='spip_form_label'> <label for="input-1-date_2">Date de début de prise</label> : </span> <input type="text" name='date_2' id='input-1-date_2' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_3'> <span class='spip_form_label'> <label for="input-1-date_3">Date de fin de prise</label> : </span> <input type="text" name='date_3' id='input-1-date_3' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_17'> <span class='spip_form_label'> <span class='label'>Motif du traitement</span> : </span> <input type='hidden' name='multiple_17[]' id='input-1-multiple_17' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_17[]' id='input-1-multiple_17_1' value='multiple_17_1' /> <label for='input-1-multiple_17_1'>Prescription médicale</label></li> <li> <input type='checkbox' name='multiple_17[]' id='input-1-multiple_17_2' value='multiple_17_2' /> <label for='input-1-multiple_17_2'>Automédication</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_17[]' id='input-1-multiple_17_3' value='multiple_17_3' /> <label for='input-1-multiple_17_3'>Pharmacodépendance</label></li> <li> <input type='checkbox' name='multiple_17[]' id='input-1-multiple_17_4' value='multiple_17_4' /> <label for='input-1-multiple_17_4'>Erreur thérapeutique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_20'> <span class='spip_form_label'> <label for="input-1-ligne_20">Autre motif du traitement (précisez)</label> : </span> <input type="text" name='ligne_20' id='input-1-ligne_20' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_1'> Deuxième médicamant pris durant la période </div> <div class='spip_form_champ ligne_21'> <span class='spip_form_label'> <label for="input-1-ligne_21">Désignation (Nom Commercial et/ou DCI, forme, dosage, présentation)</label> : </span> <input type="text" name='ligne_21' id='input-1-ligne_21' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_22'> <span class='spip_form_label'> <label for="input-1-ligne_22">N° de lot et Date de péremption</label> : </span> <input type="text" name='ligne_22' id='input-1-ligne_22' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_23'> <span class='spip_form_label'> <label for="input-1-ligne_23">Lieu de délivrance</label> : </span> <input type="text" name='ligne_23' id='input-1-ligne_23' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_24'> <span class='spip_form_label'> <label for="input-1-ligne_24">Voie et site d'admin.</label> : </span> <input type="text" name='ligne_24' id='input-1-ligne_24' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_25'> <span class='spip_form_label'> <label for="input-1-ligne_25">Posologie</label> : </span> <input type="text" name='ligne_25' id='input-1-ligne_25' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_4'> <span class='spip_form_label'> <label for="input-1-date_4">Date de début de prise</label> : </span> <input type="text" name='date_4' id='input-1-date_4' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_5'> <span class='spip_form_label'> <label for="input-1-date_5">Date de fin de prise</label> : </span> <input type="text" name='date_5' id='input-1-date_5' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_16'> <span class='spip_form_label'> <span class='label'>Motif du traitement</span> : </span> <input type='hidden' name='multiple_16[]' id='input-1-multiple_16' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_16[]' id='input-1-multiple_16_1' value='multiple_16_1' /> <label for='input-1-multiple_16_1'>Prescription médicale</label></li> <li> <input type='checkbox' name='multiple_16[]' id='input-1-multiple_16_2' value='multiple_16_2' /> <label for='input-1-multiple_16_2'>Automédication</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_16[]' id='input-1-multiple_16_3' value='multiple_16_3' /> <label for='input-1-multiple_16_3'>Pharmacodépendance</label></li> <li> <input type='checkbox' name='multiple_16[]' id='input-1-multiple_16_4' value='multiple_16_4' /> <label for='input-1-multiple_16_4'>Erreur thérapeutique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_26'> <span class='spip_form_label'> <label for="input-1-ligne_26">Autre motif du traitement (précisez)</label> : </span> <input type="text" name='ligne_26' id='input-1-ligne_26' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_2'> Troisième médicamant pris durant la période </div> <div class='spip_form_champ ligne_27'> <span class='spip_form_label'> <label for="input-1-ligne_27">Désignation (Nom Commercialet/ou DCI, forme, dosage, présentation)</label> : </span> <input type="text" name='ligne_27' id='input-1-ligne_27' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_28'> <span class='spip_form_label'> <label for="input-1-ligne_28">N° de lot et date péremp.</label> : </span> <input type="text" name='ligne_28' id='input-1-ligne_28' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_29'> <span class='spip_form_label'> <label for="input-1-ligne_29">Lieu de délivrance</label> : </span> <input type="text" name='ligne_29' id='input-1-ligne_29' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_30'> <span class='spip_form_label'> <label for="input-1-ligne_30">Voie et site d'admin.</label> : </span> <input type="text" name='ligne_30' id='input-1-ligne_30' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_31'> <span class='spip_form_label'> <label for="input-1-ligne_31">Posologie</label> : </span> <input type="text" name='ligne_31' id='input-1-ligne_31' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_6'> <span class='spip_form_label'> <label for="input-1-date_6">Date de début de prise</label> : </span> <input type="text" name='date_6' id='input-1-date_6' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_7'> <span class='spip_form_label'> <label for="input-1-date_7">Date de fin de prise</label> : </span> <input type="text" name='date_7' id='input-1-date_7' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_14'> <span class='spip_form_label'> <span class='label'>Motif du traitement</span> : </span> <input type='hidden' name='multiple_14[]' id='input-1-multiple_14' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_14[]' id='input-1-multiple_14_1' value='multiple_14_1' /> <label for='input-1-multiple_14_1'>Prescription médicale</label></li> <li> <input type='checkbox' name='multiple_14[]' id='input-1-multiple_14_2' value='multiple_14_2' /> <label for='input-1-multiple_14_2'>Automédication</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_14[]' id='input-1-multiple_14_3' value='multiple_14_3' /> <label for='input-1-multiple_14_3'>Pharmacodépendance</label></li> <li> <input type='checkbox' name='multiple_14[]' id='input-1-multiple_14_4' value='multiple_14_4' /> <label for='input-1-multiple_14_4'>Erreur thérapeutique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_32'> <span class='spip_form_label'> <label for="input-1-ligne_32">Autre motif du traitement (précisez)</label> : </span> <input type="text" name='ligne_32' id='input-1-ligne_32' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_3'> Quatrième médicament pris durant la période </div> <div class='spip_form_champ ligne_33'> <span class='spip_form_label'> <label for="input-1-ligne_33">Désignation (Nom Commercial et/ou DCI, forme, dosage, présentation)</label> : </span> <input type="text" name='ligne_33' id='input-1-ligne_33' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_34'> <span class='spip_form_label'> <label for="input-1-ligne_34">N° de lot et date péremp.</label> : </span> <input type="text" name='ligne_34' id='input-1-ligne_34' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_35'> <span class='spip_form_label'> <label for="input-1-ligne_35">Lieu de délivrance</label> : </span> <input type="text" name='ligne_35' id='input-1-ligne_35' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_36'> <span class='spip_form_label'> <label for="input-1-ligne_36">Voie et site d'admin.</label> : </span> <input type="text" name='ligne_36' id='input-1-ligne_36' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_37'> <span class='spip_form_label'> <label for="input-1-ligne_37">Posologie</label> : </span> <input type="text" name='ligne_37' id='input-1-ligne_37' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_8'> <span class='spip_form_label'> <label for="input-1-date_8">Date de début de prise</label> : </span> <input type="text" name='date_8' id='input-1-date_8' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_9'> <span class='spip_form_label'> <label for="input-1-date_9">Date de fin de prise</label> : </span> <input type="text" name='date_9' id='input-1-date_9' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_15'> <span class='spip_form_label'> <span class='label'>Motif du traitement</span> : </span> <input type='hidden' name='multiple_15[]' id='input-1-multiple_15' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_15[]' id='input-1-multiple_15_1' value='multiple_15_1' /> <label for='input-1-multiple_15_1'>Prescription médicale</label></li> <li> <input type='checkbox' name='multiple_15[]' id='input-1-multiple_15_2' value='multiple_15_2' /> <label for='input-1-multiple_15_2'>Automédication</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_15[]' id='input-1-multiple_15_3' value='multiple_15_3' /> <label for='input-1-multiple_15_3'>Pharmacodépendance</label></li> <li> <input type='checkbox' name='multiple_15[]' id='input-1-multiple_15_4' value='multiple_15_4' /> <label for='input-1-multiple_15_4'>Erreur thérapeutique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_38'> <span class='spip_form_label'> <label for="input-1-ligne_38">Autre motif du traitement (précisez)</label> : </span> <input type="text" name='ligne_38' id='input-1-ligne_38' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_4'> Cinquième médicament pris durant la période </div> <div class='spip_form_champ ligne_39'> <span class='spip_form_label'> <label for="input-1-ligne_39">Désignation (Nom Commercial et/ou DCI, forme, dosage, présentation)</label> : </span> <input type="text" name='ligne_39' id='input-1-ligne_39' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_40'> <span class='spip_form_label'> <label for="input-1-ligne_40">N° de lot et date péremp.</label> : </span> <input type="text" name='ligne_40' id='input-1-ligne_40' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_41'> <span class='spip_form_label'> <label for="input-1-ligne_41">Lieu de délivrance</label> : </span> <input type="text" name='ligne_41' id='input-1-ligne_41' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_42'> <span class='spip_form_label'> <label for="input-1-ligne_42">Voie et site d'admin.</label> : </span> <input type="text" name='ligne_42' id='input-1-ligne_42' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_43'> <span class='spip_form_label'> <label for="input-1-ligne_43">Posologie</label> : </span> <input type="text" name='ligne_43' id='input-1-ligne_43' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_10'> <span class='spip_form_label'> <label for="input-1-date_10">Date de début de prise</label> : </span> <input type="text" name='date_10' id='input-1-date_10' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_11'> <span class='spip_form_label'> <label for="input-1-date_11">Date de fin de prise</label> : </span> <input type="text" name='date_11' id='input-1-date_11' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_13'> <span class='spip_form_label'> <span class='label'>Motif du traitement</span> : </span> <input type='hidden' name='multiple_13[]' id='input-1-multiple_13' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_13[]' id='input-1-multiple_13_1' value='multiple_13_1' /> <label for='input-1-multiple_13_1'>Prescription médicale</label></li> <li> <input type='checkbox' name='multiple_13[]' id='input-1-multiple_13_2' value='multiple_13_2' /> <label for='input-1-multiple_13_2'>Automédication</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_13[]' id='input-1-multiple_13_3' value='multiple_13_3' /> <label for='input-1-multiple_13_3'>Pharmacodépendance</label></li> <li> <input type='checkbox' name='multiple_13[]' id='input-1-multiple_13_4' value='multiple_13_4' /> <label for='input-1-multiple_13_4'>Erreur thérapeutique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_44'> <span class='spip_form_label'> <label for="input-1-ligne_44">Autre motif du traitement (précisez)</label> : </span> <input type="text" name='ligne_44' id='input-1-ligne_44' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_5'> Sixième médicament pris durant la période </div> <div class='spip_form_champ ligne_45'> <span class='spip_form_label'> <label for="input-1-ligne_45">Désignation (Nom Commercial et/ou DCI, forme, dosage, présentation)</label> : </span> <input type="text" name='ligne_45' id='input-1-ligne_45' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_46'> <span class='spip_form_label'> <label for="input-1-ligne_46">N° de lot et date péremp.</label> : </span> <input type="text" name='ligne_46' id='input-1-ligne_46' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_47'> <span class='spip_form_label'> <label for="input-1-ligne_47">Lieu de délivrance</label> : </span> <input type="text" name='ligne_47' id='input-1-ligne_47' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_48'> <span class='spip_form_label'> <label for="input-1-ligne_48">Voie et site d'admin.</label> : </span> <input type="text" name='ligne_48' id='input-1-ligne_48' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_49'> <span class='spip_form_label'> <label for="input-1-ligne_49">Posologie</label> : </span> <input type="text" name='ligne_49' id='input-1-ligne_49' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_12'> <span class='spip_form_label'> <label for="input-1-date_12">Date de début de prise</label> : </span> <input type="text" name='date_12' id='input-1-date_12' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_13'> <span class='spip_form_label'> <label for="input-1-date_13">Date de fin de prise</label> : </span> <input type="text" name='date_13' id='input-1-date_13' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_11'> <span class='spip_form_label'> <span class='label'>Motif du traitement</span> : </span> <input type='hidden' name='multiple_11[]' id='input-1-multiple_11' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_11[]' id='input-1-multiple_11_1' value='multiple_11_1' /> <label for='input-1-multiple_11_1'>Prescription médicale</label></li> <li> <input type='checkbox' name='multiple_11[]' id='input-1-multiple_11_2' value='multiple_11_2' /> <label for='input-1-multiple_11_2'>Automédication</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_11[]' id='input-1-multiple_11_3' value='multiple_11_3' /> <label for='input-1-multiple_11_3'>Pharmacodépendance</label></li> <li> <input type='checkbox' name='multiple_11[]' id='input-1-multiple_11_4' value='multiple_11_4' /> <label for='input-1-multiple_11_4'>Erreur thérapeutique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_50'> <span class='spip_form_label'> <label for="input-1-ligne_50">Autre motif du traitement(précisez)</label> : </span> <input type="text" name='ligne_50' id='input-1-ligne_50' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_18'> <span class='spip_form_label'> <span class='label'>S'il s'agit d'un nouveau-né, les produits ont été pris</span> : </span> <input type='hidden' name='multiple_18[]' id='input-1-multiple_18' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_18[]' id='input-1-select_6_1' value='select_6_1' /> <label for='input-1-select_6_1'>Par le nouveau-né</label></li> <li> <input type='checkbox' name='multiple_18[]' id='input-1-multiple_18_2' value='multiple_18_2' /> <label for='input-1-multiple_18_2'>Lors de l'allaitement</label></li> <li> <input type='checkbox' name='multiple_18[]' id='input-1-multiple_18_3' value='multiple_18_3' /> <label for='input-1-multiple_18_3'> Par la mère durant sa grossesse au premier trimestre de grossesse</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_18[]' id='input-1-multiple_18_4' value='multiple_18_4' /> <label for='input-1-multiple_18_4'> Par la mère durant sa grossesse au deuxième trimestre de grossesse</label></li> <li> <input type='checkbox' name='multiple_18[]' id='input-1-multiple_18_5' value='multiple_18_5' /> <label for='input-1-multiple_18_5'> Par la mère durant sa grossesse au troisième trimestre de grossesse</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_7'> EFFET INDESIRABLE </div> <div class='spip_form_champ texte_1'> <span class='spip_form_label'> <label for="input-1-texte_1">Description de l'effet indésirable (EI)</label> : </span> <textarea name='texte_1' rows='10' class='formo ' cols='80' id='input-1-texte_1'></textarea> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_14'> <span class='spip_form_label'> <label for="input-1-date_14">Date d'apparition de l'effet</label> : </span> <input type="text" name='date_14' id='input-1-date_14' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> </fieldset><fieldset class='separateur_2'><legend>Indiquez le délai d'apparition après la prise d'un ou des produits (en heures ou jours)</legend> <div class='spip_form_champ ligne_68'> <span class='spip_form_label'> <label for="input-1-ligne_68">Après le médicament (1)</label> : </span> <input type="text" name='ligne_68' id='input-1-ligne_68' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_69'> <span class='spip_form_label'> <label for="input-1-ligne_69">Après le médicament (2)</label> : </span> <input type="text" name='ligne_69' id='input-1-ligne_69' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_70'> <span class='spip_form_label'> <label for="input-1-ligne_70">Après le médicament (3)</label> : </span> <input type="text" name='ligne_70' id='input-1-ligne_70' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_71'> <span class='spip_form_label'> <label for="input-1-ligne_71">Après le médicament (4)</label> : </span> <input type="text" name='ligne_71' id='input-1-ligne_71' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_72'> <span class='spip_form_label'> <label for="input-1-ligne_72">Après le médicament (5)</label> : </span> <input type="text" name='ligne_72' id='input-1-ligne_72' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_73'> <span class='spip_form_label'> <label for="input-1-ligne_73">Après le médicament (6)</label> : </span> <input type="text" name='ligne_73' id='input-1-ligne_73' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_6'> <span class='spip_form_label'> <span class='label'>Réapparition de l'effet après réintroduction d'un ou des produits Cochez la case du n° du produit</span> : </span> <input type='hidden' name='multiple_6[]' id='input-1-multiple_6' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_6[]' id='input-1-multiple_6_1' value='multiple_6_1' /> <label for='input-1-multiple_6_1'>(1)</label></li> <li> <input type='checkbox' name='multiple_6[]' id='input-1-multiple_6_2' value='multiple_6_2' /> <label for='input-1-multiple_6_2'>(2)</label></li> <li> <input type='checkbox' name='multiple_6[]' id='input-1-multiple_6_3' value='multiple_6_3' /> <label for='input-1-multiple_6_3'>(3)</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_6[]' id='input-1-multiple_6_4' value='multiple_6_4' /> <label for='input-1-multiple_6_4'>(4)</label></li> <li> <input type='checkbox' name='multiple_6[]' id='input-1-multiple_6_5' value='multiple_6_5' /> <label for='input-1-multiple_6_5'>(5)</label></li> <li> <input type='checkbox' name='multiple_6[]' id='input-1-multiple_6_6' value='multiple_6_6' /> <label for='input-1-multiple_6_6'>Nouveau choix</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_8'> Prise en charge </div> <div class='spip_form_champ multiple_7'> <span class='spip_form_label'> <span class='label'>Diminution de la dose du ou des produits Cochez la case du n° du produit</span> : </span> <input type='hidden' name='multiple_7[]' id='input-1-multiple_7' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_7[]' id='input-1-multiple_7_1' value='multiple_7_1' /> <label for='input-1-multiple_7_1'>(1)</label></li> <li> <input type='checkbox' name='multiple_7[]' id='input-1-multiple_7_2' value='multiple_7_2' /> <label for='input-1-multiple_7_2'>(2)</label></li> <li> <input type='checkbox' name='multiple_7[]' id='input-1-multiple_7_3' value='multiple_7_3' /> <label for='input-1-multiple_7_3'>(3)</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_7[]' id='input-1-multiple_7_4' value='multiple_7_4' /> <label for='input-1-multiple_7_4'>(4)</label></li> <li> <input type='checkbox' name='multiple_7[]' id='input-1-multiple_7_5' value='multiple_7_5' /> <label for='input-1-multiple_7_5'>(5)</label></li> <li> <input type='checkbox' name='multiple_7[]' id='input-1-multiple_7_6' value='multiple_7_6' /> <label for='input-1-multiple_7_6'>(6)</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_8'> <span class='spip_form_label'> <span class='label'>Si oui,</span> : </span> <input type='hidden' name='multiple_8[]' id='input-1-multiple_8' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_8[]' id='input-1-multiple_8_1' value='multiple_8_1' /> <label for='input-1-multiple_8_1'>l'effet a-t-il diminué</label></li> <li> <input type='checkbox' name='multiple_8[]' id='input-1-multiple_8_2' value='multiple_8_2' /> <label for='input-1-multiple_8_2'>disparu</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_8[]' id='input-1-multiple_8_3' value='multiple_8_3' /> <label for='input-1-multiple_8_3'>ou s'est-il maintenu</label></li> <li> <input type='checkbox' name='multiple_8[]' id='input-1-multiple_8_4' value='multiple_8_4' /> <label for='input-1-multiple_8_4'>ou non applicable</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_9'> <span class='spip_form_label'> <span class='label'>Arrêt d'un ou des produits Cochez la case du n° du produit</span> : </span> <input type='hidden' name='multiple_9[]' id='input-1-multiple_9' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_9[]' id='input-1-multiple_9_1' value='multiple_9_1' /> <label for='input-1-multiple_9_1'>(1)</label></li> <li> <input type='checkbox' name='multiple_9[]' id='input-1-multiple_9_2' value='multiple_9_2' /> <label for='input-1-multiple_9_2'>(2)</label></li> <li> <input type='checkbox' name='multiple_9[]' id='input-1-multiple_9_3' value='multiple_9_3' /> <label for='input-1-multiple_9_3'>(3)</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_9[]' id='input-1-multiple_9_4' value='multiple_9_4' /> <label for='input-1-multiple_9_4'>(4)</label></li> <li> <input type='checkbox' name='multiple_9[]' id='input-1-multiple_9_5' value='multiple_9_5' /> <label for='input-1-multiple_9_5'>(5)</label></li> <li> <input type='checkbox' name='multiple_9[]' id='input-1-multiple_9_6' value='multiple_9_6' /> <label for='input-1-multiple_9_6'>(6)</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ multiple_10'> <span class='spip_form_label'> <span class='label'>Si oui</span> : </span> <input type='hidden' name='multiple_10[]' id='input-1-multiple_10' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_10[]' id='input-1-multiple_10_1' value='multiple_10_1' /> <label for='input-1-multiple_10_1'>l'effet a-t-il diminué</label></li> <li> <input type='checkbox' name='multiple_10[]' id='input-1-multiple_10_2' value='multiple_10_2' /> <label for='input-1-multiple_10_2'>disparu</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_10[]' id='input-1-multiple_10_3' value='multiple_10_3' /> <label for='input-1-multiple_10_3'>ou s'est-il maintenu</label></li> <li> <input type='checkbox' name='multiple_10[]' id='input-1-multiple_10_4' value='multiple_10_4' /> <label for='input-1-multiple_10_4'>ou non applicable</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_53'> <span class='spip_form_label'> <label for="input-1-ligne_53">Examens Complémentaires (1)</label> : </span> <input type="text" name='ligne_53' id='input-1-ligne_53' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_54'> <span class='spip_form_label'> <label for="input-1-ligne_54">Examens Complémentaires (2)</label> : </span> <input type="text" name='ligne_54' id='input-1-ligne_54' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_55'> <span class='spip_form_label'> <label for="input-1-ligne_55">Examens Complémentaires (3)</label> : </span> <input type="text" name='ligne_55' id='input-1-ligne_55' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_56'> <span class='spip_form_label'> <label for="input-1-ligne_56">Résultats (1)</label> : </span> <input type="text" name='ligne_56' id='input-1-ligne_56' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_57'> <span class='spip_form_label'> <label for="input-1-ligne_57">Résultats (2)</label> : </span> <input type="text" name='ligne_57' id='input-1-ligne_57' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_58'> <span class='spip_form_label'> <label for="input-1-ligne_58">Résultats (3)</label> : </span> <input type="text" name='ligne_58' id='input-1-ligne_58' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_59'> <span class='spip_form_label'> <label for="input-1-ligne_59">Autres (précisez) :</label> : </span> <input type="text" name='ligne_59' id='input-1-ligne_59' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_9'> Gravité Cochez les cases correspondantes </div> <div class='spip_form_champ select_8'> <span class='spip_form_label'> <span class='label'>Hospitalisation</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_8' value='select_8_1' id='input-1-select_8_1' /> <label for='input-1-select_8_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_9'> <span class='spip_form_label'> <span class='label'>Prolongation d'hospitalisation</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_9' value='select_9_1' id='input-1-select_9_1' /> <label for='input-1-select_9_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_10'> <span class='spip_form_label'> <span class='label'>Pronostic vital mis en jeu</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_10' value='select_10_1' id='input-1-select_10_1' /> <label for='input-1-select_10_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_11'> <span class='spip_form_label'> <span class='label'>Incapacité permanente</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_11' value='select_11_1' id='input-1-select_11_1' /> <label for='input-1-select_11_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_12'> <span class='spip_form_label'> <span class='label'>Malformation congénitale</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_12' value='select_12_1' id='input-1-select_12_1' /> <label for='input-1-select_12_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_13'> <span class='spip_form_label'> <span class='label'>Décès</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_13' value='select_13_1' id='input-1-select_13_1' /> <label for='input-1-select_13_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_60'> <span class='spip_form_label'> <label for="input-1-ligne_60">Autres (précisez) :</label> : </span> <input type="text" name='ligne_60' id='input-1-ligne_60' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_10'> Evolution Cochez les cases correspondantes </div> <div class='spip_form_champ select_14'> <span class='spip_form_label'> <span class='label'>Guéri sans séquelle</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_14' value='select_14_1' id='input-1-select_14_1' /> <label for='input-1-select_14_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_61'> <span class='spip_form_label'> <label for="input-1-ligne_61">Guéri avec séquelles</label> : </span> <input type="text" name='ligne_61' id='input-1-ligne_61' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_15'> <span class='spip_form_label'> <span class='label'>Pas encore guéri</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_15' value='select_15_1' id='input-1-select_15_1' /> <label for='input-1-select_15_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_16'> <span class='spip_form_label'> <span class='label'>Pas connue</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_16' value='select_16_1' id='input-1-select_16_1' /> <label for='input-1-select_16_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ select_17'> <span class='spip_form_label'> <span class='label'>Décès</span> : </span> <ul class='spip_form_choix_unique'> <li> <input type='radio' name='select_17' value='select_17_1' id='input-1-select_17_1' /> <label for='input-1-select_17_1'> </label> </li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_11'> FACTEURS DE RISQUES ; ANTECEDENTS MEDICAUX ; REACTIONS ANTERIEURES AU TRAITEMENT ; </div> <div class='spip_form_champ multiple_12'> <span class='spip_form_label'> <span class='label'>Facteurs de risque</span> : </span> <input type='hidden' name='multiple_12[]' id='input-1-multiple_12' value='' /> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_12[]' id='input-1-multiple_12_1' value='multiple_12_1' /> <label for='input-1-multiple_12_1'>Tabac</label></li> <li> <input type='checkbox' name='multiple_12[]' id='input-1-multiple_12_2' value='multiple_12_2' /> <label for='input-1-multiple_12_2'>Alcool</label></li> </ul> <ul class="spip_form_choix_multiple"> <li> <input type='checkbox' name='multiple_12[]' id='input-1-multiple_12_3' value='multiple_12_3' /> <label for='input-1-multiple_12_3'>Remède traditionnel</label></li> <li> <input type='checkbox' name='multiple_12[]' id='input-1-multiple_12_4' value='multiple_12_4' /> <label for='input-1-multiple_12_4'>Traitement chronique</label></li> </ul> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_62'> <span class='spip_form_label'> <label for="input-1-ligne_62">Autres (préciser)</label> : </span> <input type="text" name='ligne_62' id='input-1-ligne_62' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_63'> <span class='spip_form_label'> <label for="input-1-ligne_63">Antécédents médicaux pertinents, réaction antérieure à un produit de santé :</label> : </span> <input type="text" name='ligne_63' id='input-1-ligne_63' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ textestatique_12'> NOTIIFIICATEUR </div> <div class='spip_form_champ ligne_64'> <span class='spip_form_label'> <label for="input-1-ligne_64">Nom / Prénom (s)</label> : </span> <input type="text" name='ligne_64' id='input-1-ligne_64' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_65'> <span class='spip_form_label'> <label for="input-1-ligne_65">Qualification</label> : </span> <input type="text" name='ligne_65' id='input-1-ligne_65' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_66'> <span class='spip_form_label'> <label for="input-1-ligne_66">Téléphone / Fax</label> : </span> <input type="text" name='ligne_66' id='input-1-ligne_66' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ ligne_67'> <span class='spip_form_label'> <label for="input-1-ligne_67">E-mail</label> : </span> <input type="text" name='ligne_67' id='input-1-ligne_67' value="" class=' ligne formo' size='40' /> <span class='nettoyeur'> </span> </div> <div class='spip_form_champ date_15'> <span class='spip_form_label'> <label for="input-1-date_15">Date</label> : </span> <input type="text" name='date_15' id='input-1-date_15' value="" class='date-picker date formo' size='40' /> <span class='nettoyeur'> </span> </div> </fieldset> <p style='display:none;'><label for="nobotnobot-1">Veuillez laisser ce champ vide :</label> <input type="text" name="nobotnobot" id="nobotnobot-1" value="" size="10" /></p> <div style='text-align:right' class='spip_bouton'><input type="submit" name='Valider' value="Valider" /> </div> <script src="http://www.dgpml.sante.gov.bf/plugins/forms_et_tables_1_9_1/javascript/jtip.js" type="text/javascript"></script> <script src="http://www.dgpml.sante.gov.bf/plugins/forms_et_tables_1_9_1/javascript/jquery-dom.js" type="text/javascript"></script> <script src="http://www.dgpml.sante.gov.bf/plugins/forms_et_tables_1_9_1/javascript/datePicker.js" type="text/javascript"></script> <script type="text/javascript"><!-- jQuery('div.spip_forms input.formo').bind('focus',function(){jQuery(this).addClass('formo-focus');}); jQuery('div.spip_forms input.formo').bind('blur',function(){jQuery(this).removeClass('formo-focus');}); jQuery('div.spip_forms input.forml').bind('focus',function(){jQuery(this).addClass('forml-focus');}); jQuery('div.spip_forms input.forml').bind('blur',function(){jQuery(this).removeClass('forml-focus');}); $.datePicker.setDateFormat('dmy','/'); $.datePicker.setLanguageStrings( ['dimanche', 'lundi', 'mardi', 'mercredi', 'jeudi', 'vendredi', 'samedi'], ['janvier', 'février', 'mars', 'avril', 'mai', 'juin', 'juillet', 'août', 'septembre', 'octobre', 'novembre', 'décembre'], {p:'précédent', n:'suivant', c:'X'} ); $('input.date-picker').datePicker({startDate:'01/01/1900'}); //--></script> </div> </form> </div></div> http://www.dgpml.sante.gov.bf/spip.php?article60 http://www.dgpml.sante.gov.bf/spip.php?article60 2009-11-26T09:38:39Z text/html fr dgpml DMPT - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique5" rel="directory">DMPT</a> http://www.dgpml.sante.gov.bf/spip.php?article100 http://www.dgpml.sante.gov.bf/spip.php?article100 2009-11-25T16:22:52Z text/html fr Préfaces I. PRESENTATION DE LA DAP <br />1.1. Introduction sur la DAP <br />La direction de l'approvisionnement pharmaceutique (DAP) est une nouvelle direction qui a été créée suite à l'adoption du décret n°2009-104/PRES/PM/MS du 02 mars 2009 portant organisation du Ministère de la santé. Elle est ainsi issue de la restructuration de la DGPML qui est passée de trois à quatre directions techniques (DL, DRP, DAP et DMPT). Au cours de l'année 2010, la DAP mettra un accent particulier sur le renforcement des capacités (...) - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique7" rel="directory">Préfaces</a> <img src="http://www.dgpml.sante.gov.bf/IMG/arton100.gif" alt="" align="right" width="276" height="234" class="spip_logos" /> <div class='rss_texte'><h3 class="spip">I. PRESENTATION DE LA DAP</h3> <hr class="spip" /> <h3 class="spip"> <strong class="spip">1.1. Introduction sur la DAP</strong> </h3> <p class="spip">La direction de l'approvisionnement pharmaceutique (DAP) est une nouvelle direction qui a été créée suite à l'adoption du décret n°2009-104/PRES/PM/MS du 02 mars 2009 portant organisation du Ministère de la santé. Elle est ainsi issue de la restructuration de la DGPML qui est passée de trois à quatre directions techniques (DL, DRP, DAP et DMPT). Au cours de l'année 2010, la DAP mettra un accent particulier sur le renforcement des capacités opérationnelles des pharmaciens des Districts, Centres hospitaliers et DRS du Burkina Faso.</p> <h3 class="spip"> <strong class="spip">1.2. Organisation et attributions de la DAP</strong> </h3> <p class="spip">Les attributions de la DAP sont indiquées dans le décret N°2009-104/PRES/PM/MS du 02 mars 2009 portant organisation du Ministère de la santé. Il s'agit principalement de :</p> <p class="spip"><span class='spip_document_107 spip_documents spip_documents_left' style='float:left; width:199px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L199xH329_produits-a345e.jpg' width='199' height='329' alt="" style='height:329px;width:199px;' class='' /></span> <span class='spip_document_125 spip_documents spip_documents_left' style='float:left; width:14px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L14xH342_ht2-3-5e9a2.gif' width='14' height='342' alt="" style='height:342px;width:14px;' class='' /></span> <br><strong class="spip">-</strong>Concevoir, coordonner et suivre la mise en œuvre d'un programme d'éducation et de sensibilisation au bon usage du médicament ;<br> <br><strong class="spip">-</strong>Concevoir, coordonner et suivre la mise en œuvre d'un programme de lutte contre les médicaments contrefaits et la vente illicite des médicaments ;<br> <br><strong class="spip">-</strong>Elaborer des normes relatives à l'approvisionnement en produits pharmaceutiques ;<br> <br><strong class="spip">-</strong>Organiser, coordonner et assurer le suivi et l'évaluation de l'approvisionnement en produits pharmaceutiques du secteur sanitaire public ; <br> <br><strong class="spip">-</strong>Organiser les activités de contrôle qualité des produits pharmaceutiques ;<br> <br><strong class="spip">-</strong>Organiser et contribuer à la promotion du système national de vigilance des produits pharmaceutiques ;<br> <br><strong class="spip">-</strong>Assurer le suivi et le contrôle des importations en médicaments et autres produits pharmaceutiques.<br></p> <h3 class="spip"> <strong class="spip">Organigramme de la DAP </strong> </h3> <p class="spip"><strong class="spip"><span class='spip_document_128 spip_documents centre' > <img src='http://www.dgpml.sante.gov.bf/IMG/gif/org-2.gif' width='520' height='385' alt="" style='height:385px;width:520px;' class='' /></span></strong> <strong class="spip"><span class='spip_document_127 spip_documents spip_documents_left' style='float:left; width:498px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L498xH18_bl2-2-8564c.gif' width='498' height='18' alt="" style='height:18px;width:498px;' class='' /></span></strong></p> <p class="spip">La DAP compte renforcer les capacités de stockage des magasins du ministère de la santé en produits pharmaceutiques au niveau de la DGPML, des DRD et des districts sanitaires. En outre, des points focaux seront responsabilisés vis-à-vis des partenaires et par rapport à certaines activités essentiels de la direction. Il s'agit entre autre de Points focaux :</p> <p class="spip"><span class='spip_document_109 spip_documents spip_documents_left' style='float:left; width:197px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L197xH346_armoire-622e7.jpg' width='197' height='346' alt="" style='height:346px;width:197px;' class='' /></span> <span class='spip_document_121 spip_documents spip_documents_left' style='float:left; width:14px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L14xH376_ht-6f2b1.gif' width='14' height='376' alt="" style='height:376px;width:14px;' class='' /></span></p> <p class="spip"><strong class="spip">-</strong>suivi du plan d'action, <br> <br><strong class="spip">-</strong>information-communication, <br> <br><strong class="spip">-</strong>suivi PNDS, <br> <br><strong class="spip">-</strong>Activités OOAS/OMS/UNICEF/Fond Mondial/Fondation Clinton,<br> <br><strong class="spip">-</strong>Relations avec les laboratoires pharmaceutiques et les grossistes répartiteurs, <br> <br><strong class="spip">-</strong>Point focal DRD Don et du circuit des subventions, de la gratuité en produits pharmaceutiques. <span class='spip_document_122 spip_documents spip_documents_left' style='float:left; width:417px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L417xH18_bl-9d32f.gif' width='417' height='18' alt="" style='height:18px;width:417px;' class='' /></span> <span class='spip_document_110 spip_documents spip_documents_left' style='float:left; width:199px;' > <img src='http://www.dgpml.sante.gov.bf/local/cache-vignettes/L199xH319_rang_dap-1cdbb.jpg' width='199' height='319' alt="" style='height:319px;width:199px;' class='' /></span></p> <p class="spip">La DAP travaille de concert avec les autres structures du ministère de la santé, les associations, les ONG, les institutions internationales, les collectivités territoriales pour le développement de la pharmacie hospitalière au Burkina Faso.</p></div> http://www.dgpml.sante.gov.bf/spip.php?article99 http://www.dgpml.sante.gov.bf/spip.php?article99 2009-11-06T07:58:41Z text/html fr dgpml Projets Réseau Ouest Africain de Laboratoires d'analyse de biologie médicale - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique9" rel="directory">Projets</a> http://www.dgpml.sante.gov.bf/spip.php?article98 http://www.dgpml.sante.gov.bf/spip.php?article98 2009-10-25T06:56:01Z text/html fr dgpml Préfaces - <a href="http://www.dgpml.sante.gov.bf/spip.php?rubrique7" rel="directory">Préfaces</a>