PATIENT'S INFORMED CONSENT
I______________________________S/O,D/O,W/O_________________________
residing at___________________________________________________________
exercising my free power of choice, hereby give my consent for myself to be
included in the study titled "PRESCRIPTION AUDIT AND REVIEW IN OPD
PATIENTS” in Guru Nanak Dev Hospital , Amritsar. I have been informed to
my satisfaction by the doctor in a manner and language that I understand
the purpose and nature of the study and safety of the procedure . I am also
aware of my right to opt out of the study at any time during the course of the
study without having to give the reasons for doing so and it would not
impact my treatment in any manner. I have not been given any incentive nor i
am under any pressure for giving my consent. I give my consent to use the
data collected to publish the present study in any publication or journal. I
have been explained about the procedure of the study and I agree to take
part in it as required.
Patient's/Guardian's name:_________ Doctor’s name:____________
Signature:_________. Signature:______________
Dated:_______. Dated:_________________
Relationship with patient:__________
