Date: {{$ActivityAssignDate}}

To,

Ms. Rashmi Parekh
Sr. GM – Sales & Marketing
Senora Division
Sun Pharma Laboratories Ltd.
SUN HOUSE CTS No. 201,
B/1, Western Express Highway,
Goregaon (E),
Mumbai-400063



Subject : To understand the in-practice usage and prescription pattern of SUSTEN SR Tablets in Threatened miscarriage/Recurrent Pregnancy Loss patients in real-life clinical practice


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 the study plan and Data Collection Forms (DCF)

  • SUSTEN SR Tablet would be prescribed by me as in my routine practice.

  • The patient’s identity will not be disclosed in the DCF.

  • I will be responsible for seeking patient consent and for verifying the information in the DCF with that of the patient’s case papers and reports.


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

Name:* {{$doctorName}}
Qualifications:
Specialty
Postal Address:
PIN Code :
Clinic/Hospital Tel. No.:
Residence tel. Number:



Yours sincerely,

[Signature]
{{$doctorName}}