Pharmanova Specialties - Activity Management Form (AMF)

Name of PE/PM HQ CHENNAI

Name of APH/RPH HQ CHENNAI
Zone SOUTH Request Dt
Dr Details
Drs Name Spcl Gynec
Address
Phone Nos Dr Code:
e-mail id
DOB DOA
Attached Chemist-1 Phone No
Attached Chemist-2 Phone No
Activity
Activity Type BMD Camp OA Camp OPD camp Gynec camp
Mention (Y)
AMF type First Repeat

No. of Patients expected

Cost of Activityweiging machine

Vender details
SUNDAR SCALE SERVICES
Payment details
Business Details
last 3 Months Camp day expected Next 3 month - Expected
Products Prescribed business
*No request to be
approved for Clafect/
Naeva group
Business Given
(last 2 months - in Lacs)
*Do Not consider
business value for
Clafect/ Naeva group for
PMF

Business Expected Value

(Lacs) in the complete
year
*Do Not consider ROI Times
business value for
Clafect/ Naeva group for
PMF

Approval details
Visit Dates
Employee Approved By
Current Month (n) OCT SEP AUG
PE/PM

APH/RPH 1

BPH/ZPH
PH
Remarks by PH

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For Office Use only

Status Recvd on Vender confirmation Approved By Processed on

PMT
 Approved By
VP Operations