Regulations on Management of Medicament Samples and Gifts Article 14
For applications for medicament samples for personal use in accordance with the stipulations of Article 2, Subparagraph 4, the following materials shall be submitted:I. An international parcel claim or customs bill of lading where the recipient is the patient.II. Outer box, instructions, package insert or catalog for the medicament.III. An affidavit stating that the approved medicament sample will absolutely not be sold, transferred or re-supplied to other patients.Where the sample applied for is a prescription drug or medical device, the diagnosis certificate and prescription issued by a domestic medical institution or the diagnosis certificate and prescription issued by the original foreign medical institution recognized by the central health competent authority shall also be submitted.In addition to the material prescribed in the stipulations of the preceding two paragraphs, when necessary, the central health competent authority may order the applicant to attach the Certificate for Foreign Government for the medicament issued by the country of origin.
中文原文 藥物樣品贈品管理辦法第14條
依第二條第四款規定申請藥物樣品自用者,應檢附下列資料:
一、收件人為病患姓名之國際包裹招領單或海關提單。
二、藥物外盒、說明書、仿單或目錄。
三、載明「經核准之藥物樣品絕不出售、轉讓與轉供治療其他病患之用」之切結書。
申請樣品屬處方藥品或醫療器材者,並應檢附國內醫療院所出具之診斷證明及醫師處方,或由中央衛生主管機關認定之國外原就診之醫療院所出具之診斷證明及醫師處方。
除前二項規定資料外,必要時,中央衛生主管機關得令申請者檢附藥物原產國上市證明。
一、收件人為病患姓名之國際包裹招領單或海關提單。
二、藥物外盒、說明書、仿單或目錄。
三、載明「經核准之藥物樣品絕不出售、轉讓與轉供治療其他病患之用」之切結書。
申請樣品屬處方藥品或醫療器材者,並應檢附國內醫療院所出具之診斷證明及醫師處方,或由中央衛生主管機關認定之國外原就診之醫療院所出具之診斷證明及醫師處方。
除前二項規定資料外,必要時,中央衛生主管機關得令申請者檢附藥物原產國上市證明。