Principal Investigator: Site Principal Investigator (if different than above): Study Title: IRB Protocol #: Sponsor: Name of Drug: Quantity Date Participant Participant Quantity Date Dispensed Dose* Returned/ Returned/ Comments ID Initials Dispensed Dispensed by (name) Lot No. disposed Disposed *Include route of administration, e.g., topical, oral, subcutaneous, or intravenous.
Principal Investigator: Site Principal Investigator (if different than above): Study Title: IRB Protocol #: Sponsor: Name of Drug: Lot No. Participant ID Participant Initials Dose* Quantity Dispensed Date Dispensed Quantity Returned/ disposed Date Returned/ Disposed Dispensed by (name) Comments *Include route of administration, e.g., topical, oral, subcutaneous, or intravenous.
Drug-Accountability-Log-8-1-2014.docx