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To,
Amit Shukla
Senior General Manager
Sales and Marketing
Maxxim Division
Sun Pharmaceutical Industries Ltd.
Sun House, CTS No. 201 B/1,
Western Express Highway,
Goregaon (E),
Mumbai - 400 063
Tel: + 91 22 4324 1234/4324
Dear Amit Shukla,
Subject : In-Practice Usage and Performance (IPUP) Study of Phlogam
In response to your letter, IPUP/Phlogam/Maxxim /May’23, dated 5th May 2023, 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 study plan, CRF and full prescribing information.
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Phlogam will be prescribed and purchased as in my routine practice.
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The patients’ identity will not be disclosed in the CRF.
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I have to report serious adverse events (SAE), if any, immediately to your monitor or to you in the AE reporting form.
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You will provide the assistance of a monitor to verify the information in the CRF with
that in the patients’ case papers and reports.
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You will pay me by cheque a fee of Rs. {{$contractAmount}}/- , and accordingly, on receiving the completed CRFs, 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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