4/18/2021 Usage of Common Medicines in our Neighborhood

Usage of Common Medicines in our

Neighborhood
Below form is intended to collect information as part of a research study regarding the
usage of common medicines in our neighborhood by your family members.

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4/18/2021 Usage of Common Medicines in our Neighborhood

Area of Residency:

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Number of Family Members who take regular Medicines:

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List down the diseases / illness for which regular medicines are taken for by your
family members:

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List down the Medicines which your family members take regularly:

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4/18/2021 Usage of Common Medicines in our Neighborhood

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