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Upload order HCQA enquiry:
via excel upload/ SKU and quantity*
Upload Registration Documents/
Enter Hospital Registration Number*
Use of Information:
All the information provided by you in this form is correct and complete. By filling up and submitting this form, you authorize us to use all the information, so submitted by you, for our commercial or other official purposes whatsoever, without any further consent from you or consultation with you or any other person submitting the information.
I confirm that I have read and understood the terms of this form. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily. I further confirm that the consent provided by me herein shall constitute a valid and binding consent for the purposes of all applicable laws.

I further acknowledge that I am responsible for all the information submitted by me and I take full responsibility for the information submitted above, including its legality, reliability, appropriateness, originality, and copyright and ownership otherwise.
IMPORTANT NOTE:
Please note :
Hydroxychloroquine is a prescription drug and should be taken only under strict medical supervision and/ or prescription by a registered medical practitioner in India.