1. NAME OF THE CASE REPORT TITLE, NAME SPECIALIZATION CITY COUNTRY INTERNATIONAL PRM CONGRESS PRAGUE, CZ

2. Patient´s Data Initials: Gender: Age: Occupation: Smoking: Weight: Height: Allergy/-ies: INTERNATIONAL PRM CONGRESS PRAGUE, CZ

3. Diagnosis Presumptive diagnosis (should not be final) : INTERNATIONAL PRM CONGRESS PRAGUE, CZ

4. Personal history INTERNATIONAL PRM CONGRESS PRAGUE, CZ

5. History of Medications Overview of Used Drugs: Active Substance, Strenght, Dosage, Lenght of Using INTERNATIONAL PRM CONGRESS PRAGUE, CZ

6. Treatment Using PRM Overview of Used FRM Preparations: Active Substance, Strenght, Dosage, Lenght of Using INTERNATIONAL PRM CONGRESS PRAGUE, CZ

7. Course of Treatment INTERNATIONAL PRM CONGRESS PRAGUE, CZ

8. Concomitant Treatment During PRM Treatment Overview of Used Drugs: Active Substance, Strenght, Dosage, Lenght of Using INTERNATIONAL PRM CONGRESS PRAGUE, CZ

9. Discussion Including Determing the Final Diagnosis INTERNATIONAL PRM CONGRESS PRAGUE, CZ

10. Conclusion INTERNATIONAL PRM CONGRESS PRAGUE, CZ

11. Literature INTERNATIONAL PRM CONGRESS PRAGUE, CZ

12. Additional Information Results of Laboratory Tests (if available) : Pharmaco-Economic Analysis: INTERNATIONAL PRM CONGRESS PRAGUE, CZ