NAME OF THE CASE REPORT

TITLE, NAMESPECIALIZATION

CITYCOUNTRY

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Patient´s Data• Initials:• Gender:• Age:• Occupation:• Smoking:• Weight:• Height:• Allergy/-ies:

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Diagnosis

• Presumptive diagnosis (should not be final):

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Personal history

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

History of Medications

• Overview of Used Drugs:Active Substance, Strenght, Dosage, Lenght of Using

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Treatment Using PRM

• Overview of Used FRM Preparations:Active Substance, Strenght, Dosage, Lenght of Using

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Course of Treatment

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Concomitant Treatment During PRM Treatment

• Overview of Used Drugs:Active Substance, Strenght, Dosage, Lenght of Using

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Discussion Including Determing the Final Diagnosis

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Conclusion

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Literature

INTERNATIONAL PRM CONGRESS PRAGUE, CZ

Additional Information

• Results of Laboratory Tests (if available):

• Pharmaco-Economic Analysis:

INTERNATIONAL PRM CONGRESS PRAGUE, CZ