Date: {{$ActivityAssignDate}}

To,


Mr. Sunil Jajoo


VP & Cluster Head, Dermatology

Sun Pharmaceutical Industries Ltd.


Dear {{$doctorName}},


Subject: Real World Evidence (RWE) Study of Bilastine


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, ___ CRF

  • Bilastine will be prescribed as in my routine practice

  • The patients’ identity will not be disclosed in the CRF

  • I have to report serious adverse events (SAE), if any, immediately to your monitor or to you in the AE reporting form

  • You will provide the assistance of a monitor to verify the information in the CRF with that in the patients’ case papers and reports


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

Name: {{$doctorName}}
Qualifications:
Speciality:
Postal Address:
PIN:
Clinic or Hospital Telephone Number:
Residence Telephone Number:

Yours sincerely,

[Signature & Stamp]
{{$doctorName}}