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Human respiratory syncytial virus / Chemistry / Methadone / Bronchopulmonary dysplasia / Biology / Organic chemistry / AstraZeneca / Palivizumab / Viral diseases


RESPIRATORY SYNCYTIAL VIRUS PROPHYLAXIS REQUEST FORM Section 1 Date of Request: Patient Reference #
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Document Date: 2010-04-07 12:29:54

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File Size: 56,70 KB

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Company

Abbott Laboratories Ltd / Integra / Authority (check one) Eastern Western Central Labrador-Grenfell Shipping / /

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IndustryTerm

assessment tool / /

MedicalCondition

bronchopulmonary dysplasia / chronic lung disease/ bronchopulmonary dysplasia / acyanotic congenital heart disease / /

MedicalTreatment

surgery / /

Organization

Regional Health Authority / /

Person

Janeway / Children / /

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Position

PHYSICIAN / representative / Governor / requesting physician / RSV Pediatrician / /

Product

Synagis / /

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