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Novo Nordisk Formulary: ROFE /QA /F/01

Edition: 01
Quality
Page 1 of 1

LOG AND FOLLOW UP ON CC/AE

Reference Country Description of CC/AE Date receipt Product Name Expire date Conclusion Conclusion Send to
No. Batch number Date costumer
CC/AE

CC200701 Indonesia

This is a quality record and a print must be made after each entry / change and this print must be signed and filed.

Signature:________________________________________________________ Date:______________________

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