Drug Information Requests

 

Please use the request form below to ask a non-urgent drug information question. Every attempt will be made to respond to the request in a timely fashion.

If your request is urgent, such as a potential poisoning or overdose, please contact the Poison Center by calling 1-800-222-1222.

Requestor’s Name (Required)

Title (Required)

Business/Institution (Required)

Phone Number (Required)

Fax Number (Required)

Your Email (Required)

Enter your detailed drug information question: (Required)

Pertinent Patient Information:
Note: Please DO submit patient information that you feel may be helpful in answering the drug information request (such as patient's age, disease states, or medications). Due to HIPAA regulations please DO NOT submit patient identifying information (such as patient's name, birth date, hospital room number, social security number or medical record number).

Age

Gender

Height

Weight

Allergies

Diagnosis/Disease State

Current Medications

Type of Request
 Product Identification Dosage/Administration General Information Drug Availability Adverse Drug Reaction Drug Interactions Therapeutic Use Literature Retrieval Pregnancy/Lactation Abuse/Addiction Toxicology Cost Kinetics Investigation Drug Stability/Compatibility Other

If you selected "Other" as your Type of Request, please specify:

Choose the priority of the request:
For high priority requests, consider calling the Wellness Center directly at 864-938-3930.

Request Termination Date:
Under some circumstances, it may not be possible to provide a response within the desired time frame. Please enter a date & time (MM-DD-YY-HR) in which the requested information would be too late to be useful (Required).

Preferred Method of Response
 Email Phone Fax

Please be aware our hours of operation are Tuesday-Thursday from 9am-4pm EST. Requests submitted outside of these hours will be address during the next business day. For High Priority requests, please call our office at 864-938-3930.

Please be sure the form is complete, then click the "Send" button.