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To,
Dr. Amee Mane
Sun Pharma Industries Ltd
Sun House, Goregaon east, Mumbai.
Dear {{$doctorName}},
Subject: Assessment of
statin utilization and degree of lipid control in patients with
Type 2 Diabetes and
hypertension with ASCVD or its risk factors (BEAT-CVD - II
Study)
In response to your letter
dated _________, I give my consent to participate in the above
captioned
study bearing protocol number SP/CVD/BEAT-CVD-II /RWE-03-2023
I understand that:
- You
will provide me with a copy of the study Protocol and the
requisite number of Data Collection
forms (DCFs)
- The
DCFs will capture data as defined in the Protocol, including
laboratory results as prescribed
and performed in accordance with my routine clinical practice
and no fresh laboratory or any
investigations will be conducted for the said study
- The
patient’s identity shall not be disclosed in the DCF
- I
will ensure to capture all available information accurately and
completely in the DCF provided
- I
understand and agree to allow an independent Contract Research
Organization (CRO) to visit the
study center and compare the information supplied in the DCF to
that in medical records
My
personal details are given below for accuracy of your records.
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