Alkem

Patient No *

Patient Initials *

Date of Enrollment *

Investigator *

Site *

Subject Initials *

Gender *

Male Female

Age (in Years) *

Weight *

Height *

Date of Enrollment *

Medical History *

Presented complaints *

Disease Characteristics *

Duration of osteoarthritis Affected joints

Comorbidities *

Hypertension Diabetes Cardiovascular diseases

Baseline Pain Intensity Scores*

Visual Analog Scale (VAS) or Numerical Rating Scale (NRS): (Between 1 to 100)

Treatment Regimen *

Polmacoxib Dosage Frequency of Administration Duration of Treatment Concomitant Medications for Osteoarthritis

Adverse Events *

Type Severity

Additional Notes

Demographic Information