2 Tesseneer Drive, Highland Heights, KY 41076-9167
Telephone: +859 781 8877   Fax: +859 781 9310
Email: support@ppdi.com
PPD
Home   Call Log   Specification Sheet  
Current User: Shelly Smith (ssmith01)    Last Login: 08:59 06-Dec-2007
Caller
Information
Caller Name: Phone: Fax: Study Number: Site Number:
Fred Smith - Investigator 763-234-5678 763-235-2323 10001 101
Email: Phone Toll Free: Fax Toll Free: Protocol Number: Call Start Time/Date:
fredsmith@investigator.com 888-234-5678   12321 09:05 06-Dec-2007
= changes from completion of DDE, sample entry = recent change = all tests reported
P
= pending test  
Resident Information
Screening ID:
100001
Randomization ID:
123456
Accession ID:
888888
Initials:
AAA
DOB:
12-Nov-1973
Gender:
Male
Site Information
Mailing Address:
1234 Main Street, New Hope, MN 55428-3623
Phone:
763-404-1443
Fax:
763-553-9796
Email:
abccompany@somewhere.com
Visit History
Visit 1
DSR: 02-Nov-2007
Visit 2
DSR: 14-Nov-2007
Visit 3
DSR: 21-Nov-2007
Visit 4
DSR:
Visit 5
Visit 6
Visit 7
Visit 8
Visit 9
Visit 10
Visit 11
Visit 12
Visit 13
Visit 14
Visit 15
Sample Type
Test
Reported
Urine
Heam
Hbalc
Chemistry
Lipid
P
Storage  
Test
Reported
Urine
Heam
Hbalc
Chemistry
Lipid
P
Storage  
Test
Reported
Urine
Heam
Hbalc
Chemistry
Lipid
P
Storage  
Test
Reported
Urine
P
Heam
P
Hbalc
P
Chemistry
P
Lipid
P
Storage  
                     
Current
Resident      
Queries (3)
Subject
Visit #
# of Issues
Date
Fax Queries to Site?
Select all
100001
2
2
04-Nov-2007
100001
3
1
15-Oct-2007
Current
Site
Queries (16)
Subject
# of Issues
Date
Fax Queries to Site?
Select all
1
04-Nov-2007
100006
5
15-Oct-2007
100010
6
13-Oct-2007
100015
2
07-Oct-2007
100021
2
21-Sept-2007
 
  Fax: 763-553-9796   Additional Fax?:
Yes No