CIPLAEVANS

Clinical Meeting Report

Name of Representative: Working Month : Date: Venue: Topic: Number of Attendees:

Territory:

Doctors …………….. Pharmacists …………... Lab. Scientist ………………. Nurses ………………….... Others (Specify profession) ..

1

Questions & Answers. QUESTION 1 ANSWER 2 3 4 5 2 .

General Remarks / Comments (Include orders obtained & plans for follow up) EXPENSES Refreshments Honorarium Presentation fee Miscellaneous TOTAL _______________ =N= _______________ …………………………. Rep’s signature/Date …………………………… Area Manager’s Sign/Date 3 .

Head of Medical/Regulatory 4 .M.M. P. A.Clinical Meeting Report Feedback COMMENTS M.M.

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