STUDY DRUG ACOUNTABILITY LOG PRINCIPAL INVESTIGATOR_______________________ Clinical research Coordinator_____________________ Protocol name and/or Number_____________________ Name of the Study Drug__________________________ Subject Lot or # Amount Total Initials Date Date #of Total Balance: Comments: Initials ID# Kit Bottles, of study Amount Dispensed returned Bottles, amount Number Subject lost, and/or Number Vials, Drug per Vials, returned Dispensed discarded initials etc. bottle, etc. Less Vial, etc. Returned Number returned
STUDY DRUG ACOUNTABILITY LOG PRINCIPAL INVESTIGATOR_______________________ Clinical research Coordinator_____________________ Protocol name and/or Number_____________________ Name of the Study Drug__________________________ Subject ID# and/or initials Lot or Kit Number # Bottles, Vials, etc. Amount of study Drug per bottle, Vial, etc. Total Amount Initials Date Dispensed Date returned #of Bottles, Vials, etc. Returned Total amount returned Balance: Number Dispensed Less Number returned Comments: Subject lost, discarded Initials
STUDY%20DRUG%20ACOUNTABILITY%20LOG.docx