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In response to your letter, IPUP/MOXCLAV/Stanlife/Apr 2023, dated 20th Apr, 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 of MOXCLAV.
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MOXCLAV 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. 2500 (Rs Two Thousand Five Hundred) per patient, and accordingly, on receiving the completed CRFs,
of these patients, 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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