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Participate in study as subject | Page | Omega Medika Farma Laboratori
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Participate in study as subject

Form Participate in study as subject

This is an official research that has obtained permission from the Health Research Ethics Committee and the National Food and Drug Administration (BPOM) which aims for drug development.
Prior to participating in the study, you will undergo a medical examination and an interview with a doctor. The information you provide or obtain from this research will be kept confidential.
During the research, you will stay at the study location to take treatment and medical examinations. You will be supervised by professional health care personnel during this research
You will receive financial compensation as a replacement for transportation costs, lost time/workdays and discomfort while participating in the research.
If you decide to participate in this research, you will be asked to follow our rules and schedule which will be informed further.
All the registration process, examination and medical treatment you received during study are free of charge.
Jika Bersedia Silahkan Mengisi Form Dibawah Ini :
Jenis Kelamin
Apakah Saudara sedang hamil atau menyusui ?
Tanggal Lahir
Apakah Saudara Perokok ?
Apakah Saudara Mengkonsumsi Alkohol ?
Apakah Saudara Memiliki Alergi Obat ?
Apakah Saudara Memiliki Riwayat Penyakit Berikut ?
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