Date: {{$ActivityAssignDate}}

Subject: Understanding Usage of pancreatic exocrine replacement therapy (PERT) in pancreatic exocrine insufficiency (PEI) associated with Chronic Pancreatitis.

In response to your letter dated _________, I agree to participate in the study as outlined by you.


I understand that:


  • You will provide me with a copy of data collection form.

  • This data collection form will have questions about patient profile in routine clinical practice and usage of pancreatic enzyme supplements in the management of exocrine pancreatic insufficiency.

  • No prospective data will be captured in this study

  • No patient related data will be captured in this study

  • You will provide the assistance of a monitor to verify and to collect the DCF.


My personal details are given below for accuracy of your records.

Name: {{$doctorName}}
Qualifications:
Speciality :
Postal Address:
PIN Code :
Clinic or hospital telephone No. :
Residence telephone No. :

Yours sincerely,

[Signature]
{{$doctorName}}