Study: (Title and Number) Sponsor /producer : Centre No: (Multicentre studies) Principal Investigator: Medical Device Batch (if applicable) (fill in one scheme per Name intervention) Amount per unit (if applicable) Storage conditions Storage location ExpiryDate (if applicable) NUMBER DISPENSED/USED TOTAL RETURNED Monitored received Date Subject Number number in Date Number returned Sign COMMENTS Date dispensed storage Sign (e.g. returned unused, lost etc.) Number Initials Sign (sign / date) Controlled by /
Study: (Title and Number) Sponsor /producer : Centre No: (Multicentre studies) Principal Investigator: Medical Device (fill in one scheme per intervention) Name Amount per unit (if applicable) Batch (if applicable) Storage conditions (if applicable) Storage location ExpiryDate NUMBER received DISPENSED/USED TOTAL RETURNED Monitored Date Subject Number dispensed number in storage Sign Date Number returned Sign COMMENTS (e.g. returned unused, lost etc.) Date Number Initials Sign Controlled by / (sign / date)
mu-app-04-accountability-of-medical-device.docx