Program ID: psp-opl-2013-001

(GPORT-0261)

Monthly Report for Doppler Program at OPL (Patient Support Program)

For Month/Year: _S.Anas Takreem__ (09/2016)
Sr.
No.

Date
Conducted
(DD/MM/YYY
Y)
12/09/16

Name of HCP
Requesting Doppler

Dr. Hashimuddin

Clinic/Hospital

KTH

City

Psh

No. of
Patient
s

Any Safety
Information*

Nill

Name of OPL
Personnel
(PPO)
Conducting
Program
Fazal/Sohail

Name of Field Manager: _S.Anas Takreem

Date of Report: ___3/10/16____________

Base Town: ___Peshawar__

Signature: ___________________

Program ID: psp-opl-2013-001

(GPORT-0261)
*Adverse Event / Safety Information must be reported within 1 calendar day of Awareness Date