What Information Do You Need to Provide?

The INTIS coordinator will ask for the following information:

• Exact name of the medication, drug, disease, type of X-ray or other agent of concern
• Exact dose, if possible (how many tablets, what strength, how much alcohol, how many shots, how many X-rays)
• Duration of the exposure (how many days medication was taken, how many times per week alcohol was consumed)
• Date(s) during which exposure took place
• Last menstrual period and current gestation of the patient
• Any family history of birth defects or genetic disease
• Maternal conditions and/or any major complications in the pregnancy

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