Visit Checklist - Sample
Visit Checklist Version 1.0
STUDY NAME
Site Number:
Pt_ID:
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Visit Date:
__ __ / __ __ __ / 2 0_ __ __
d d m m m y y y y
1. Did the participant attend this visit? Yes (If yes, continue) No
2. Please check all assessments completed at this visit:
Visit Name: Baseline
Demographics
Medical History
Vital Signs
Physical Exam
Prior and Concomitant Medication
Inclusion/Exclusion Criteria
Randomization and Enrollment
3. Is the participant continuing in the study? Yes No
If no, remember to complete a STUDY COMPLETION form.
If yes, schedule next visit.
Comments:
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