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Retrospective Analysis of Effect of Vitamin D3 Supplementation in Adults in India

Patient No *

Patient Initials *

Demographic Information

Gender *

Male Female Other

Age (in Years) *

Height (in cm) *

Weight (in Kg) *

Date of Enrollment *

Medical History*

Presented complaints*

Diagnosis*

Co-existing Medical Conditions*

Concomitant medications*

Vitamin D Supplementation Protocol *

Dosage *

Frequency *

Duration *

Baseline visit

Vitamin D Level (ng/mL) *

Reported Symptoms ( List of symptoms and severity rating, if applicable)

Co-morbidities *

List presenting symptoms that may influence to suspect Vitamin D3 deficiency

In general, current patient health after vitamin D3 supplementation *

(Excellent : 1 , Very good : 2, Good : 3, Fair : 4, Poor :5)

In general, current patient health after calcium & vitamin D3 supplementation *

Vitamin D levels after 3 months therapy	Improvement in overall health score over period of 3 months	Improvement in VAS (In case presenting symptom is pain)
ng/ml	%	%

Adverse Events *

Any adverse events related to vitamin D supplementation *