PROVIDED RETURNED Date Visit Date Visit Staff Staff PTID Provided Code Comments Returned Code Ring Status Initials Initials (dd-MMM-yy) (##.#) (dd-MMM-yy) (##.#) Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned
PROVIDED RETURNED PTID Date Provided (dd-MMM-yy) Visit Code (##.#) Staff Initials Comments Date Returned (dd-MMM-yy) Visit Code (##.#) Ring Status Staff Initials Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned Used ring for testing: date to lab_________ Used ring for destruction: bin # __________ Unused ring to pharmacy Ring not returned
mtn-038_site-specific_clinic_study_product_accountabilty_log.docx