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To,
Sun Pharma Laboratories Limited
SUN House,
Mumbai.
Subject : An multicentric, observational retrospective, cross-sectional survey study to assess the utilization
pattern of Acebrophylline plus N- Acetylcysteine combination in Chronic obstructive pulmonary disease
(COPD)
In response to your letter dated ___________., I agree to participate in the study as outlined by you.
I understand that:
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You will provide me with a copy of the data collection plan and ____ DCFs.
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All the data shared by me will be retrospective in nature.
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The patient’s identity will not be disclosed in the DCF.
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You will pay me by cheque a fee of Rs ….. per patient, and accordingly, on receiving the completed
DCFs, of number of suggested patients, as a compensation for the extra time spent in record keeping.
The cheque for fee may be drawn in favor of
“________________________________________________________________________________________________.”
My personal details are given below for accuracy of your records.
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