STUDY VISIT CHECKLIST
Ensure consistency and documentation of study visits.
Principal
Investigator: ____________________ IRB#: ______________________
Sponsor: _________________________ Study
Title:
_______________________________________________________________________________________________
SUBJECT ID: DOB:
INFORMED CONSENT |
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PI/Authorized Staff Explained Study |
PI/Staff: |
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Copy of consent given to adult subject and/or LAR; child subject and/or Parent or Legal Guardian |
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Adult Subject and/or LAR; Child Subject and/or Parent or Legal Guardian- Signed Consent |
Date Signed: |
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Is Consent Valid? |
YES NO |
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If subject did not sign consent, explain: |
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STUDY VISITS |
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**Please customize this form to meet the visit requirements of your specific study. |
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Study Visit 1: |
Date Completed: |
PI/Staff Initials |
If subject did not complete test or completed test on different date, please explain: |
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e.g. Complete Blood Count |
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e.g. Pulmonary Function Test |
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e.g. EKG |
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e.g. Chest x-ray |
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Study Visit 2: |
Date Completed: |
PI/Staff Initials |
If subject did not complete test or completed test on different date, please explain: |
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Study Completion: |
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If subject did not complete study, please explain: |
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Subject Completed Study |
Date Completed: |
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If applicable, study reimbursement |
Date Given: |
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NOTES: |
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Page _____ of _____
3 RADIOCOMMUNICATION STUDY GROUPS SOURCE DOCUMENT 4CTEMP42(REV1)
6 7BL13E INTERNATIONAL TELECOMMUNICATION UNION RADIOCOMMUNICATION STUDY
9 7D129 (ANNEX 3)E RADIOCOMMUNICATION STUDY GROUPS
Tags: study visit, applicable, study, study, documentation, checklist, ensure, visit, consistency