STUDY VISIT CHECKLIST Ensure Consistency And Documentation Of Study

study visit checklist ensure consistency and documentation of study visits. principal investigator: ____________________ irb#: ________

STUDY VISIT CHECKLIST
Ensure consistency and documentation of study visits.
Principal Investigator: ____________________ IRB#:
______________________ Sponsor: _________________________
Study Title:
_______________________________________________________________________________________________
SUBJECT ID: DOB:
INFORMED CONSENT
================
PI/Authorized Staff Explained Study
PI/Staff:
Copy of consent given to adult subject and/or LAR; child subject
and/or Parent or Legal Guardian
Adult Subject and/or LAR; Child Subject and/or Parent or Legal
Guardian- Signed Consent
Date Signed:
Is Consent Valid?
YES NO
If subject did not sign consent, explain:
STUDY VISITS
**Please customize this form to meet the visit requirements of your
specific study.
Study Visit 1:
Date Completed:
PI/Staff Initials
If subject did not complete test or completed test on different date,
please explain:
e.g. Complete Blood Count
e.g. Pulmonary Function Test
e.g. EKG
e.g. Chest x-ray
Study Visit 2:
Date Completed:
PI/Staff Initials
If subject did not complete test or completed test on different date,
please explain:
Study Completion:
If subject did not complete study, please explain:
Subject Completed Study
Date Completed:
If applicable, study reimbursement
Date Given:
NOTES:
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