History Log |
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| Site Details |
| Mailing Address: 1234 Main Street, New Hope, MN 55428-3623 |
| Phone: 763-404-1443 |
| Fax: 763-553-9796 |
| Email: abccompany@somewhere.com |
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| Monitor Details |
| Name: John Smith |
| Mailing Address: 4211st St SW, Cleveland, OH 44321 |
| Phone: 555-123-1212 |
| Fax: 555-123-1244 |
| Email: qrscompany@thisplace.com |
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| Resident Details |
| Screening ID: 100001 |
| Randomization ID: 123456 |
| Accession ID : 888888 |
| Initials: AAA |
| DOB: 12-Nov-1973 |
| Gender: Male |
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| Clinical Details |
| Visit 1- Fasting, Weight: 185lbs |
| Visit 2 - Fasting, Weight: 186lbs |
| Visit 3 - Fasting, Weight: 185lbs |
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| Samples Details |
| Visit 1- Draw Date: 01-Nov-2007: Urine, Heam, Hbalc, Chemistry, Lipid |
| Visit 2 - Draw Date: 05-Nov-2007: Urine, Heam, Hbalc, Chemistry, Lipid |
| Visit 3 - Draw Date: 15-Nov-2007: Urine, Heam, Hbalc, Chemistry, Lipid |
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