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CONCOMITANT MEDICATION LOG TEMPLATE. STUDY NO. STUDY TITLE. PRINCIPAL RESEARCHER. SUBJECT ID. SUBJECT INITIALS. Ask Participant: Are you currently taking ...
Typology: Summaries
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dd/mm/yy
dd/mm/yy
Yes / No
Yes / No Signature of Principal Researcher Date *To be signed at the end of the study
CODING CODE DOSE UNITS FORM
10 Gel 11 Cream 12 Powder 13 Implant 14 Chewable 15 Liquid 99 Other, define Other, define Other, define QD (once/day)
BID (twice/day) TID (three/day) QID (four/day) QOD (every other day) AC (before meals) PC (after meals) Other, define
Oral Topical Subcutaneous Intradermal Transdermal Intraocular Intramuscular Inhalation Intravenous Intraperitoneal Nasal QM (every month) QOM (every other month) QH (every hour) Vaginal Rectal PRN (as needed)