Date: {{$ActivityAssignDate}}

To,


Sun Pharma Laboratories Limited

SUN House,

Mumbai.


Subject : Effect of ICS+LABA on FunctionAl (Spirometer findings) and Clinical ouTcomes (need of rescue medicine) in newly diagnosed COPD


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 data collection plan and __ DCFs

  • All the data shared by me will be retrospective in nature.

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


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

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

*Mandatory to be filled




Yours sincerely,

[Signature]
{{$doctorName}}