After administering it, the health professional draws up an administration record which includes the following information:
1° The name of the advanced therapy medicinal product prepared on an ad hoc basis;
2° The name and address of the establishment or body mentioned in Article L. 4211-9-1 or the pharmaceutical establishment mentioned in Article L. 5124-1 or Article L. 5124-9-1 ;
3° The patient’s surname, first name and date of birth;
4° The product code, batch number and, where applicable, the donation identification number;
5° The name of the healthcare professional administering the advanced therapy medicinal product prepared on an ad hoc basis;
6° The indication for administration of the medicinal product;
7° The dose administered;
8° The date and time of administration of the medicinal product;
9° Any complications that may have arisen.
The completed form is kept in the patient’s medical file defined in article R. 1112-2. A copy of this form is sent to the establishment or body mentioned in article L. 4211-9-1 or to the pharmaceutical establishment mentioned in article L. 5124-1 or article L. 5124-9-1, which is responsible for preparing and distributing this medicinal product.
When the medicinal product has not been administered to the patient, the healthcare professional shall state in this form the reasons why the medicinal product was not administered and what has become of it, in particular whether it has been stored or destroyed.