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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:
James Mills - Monitor 555-555-5678 555-555-2323 10001 101
Email: Phone Toll Free: Fax Toll Free: Protocol Number: Call Start Time/Date:
jamesmills@monitor.com 888-555-5678   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: 100022 Randomization ID: 9999999 Accession ID: 265987
Initials: DFE DOB: 24-Sep-1964 Gender: Female
 
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 Samples Clinical History
DSR: 13-Apr-2007 Exp: 6 Fasting
  Rec'd: 4 Weight: 145 lbs
Visit 2 Samples Clinical History
Create DSR Exp: 6 Fasting
  Rec'd: 4 Weight:143 lbs
Visit 3 Samples Clinical History
Create DSR Exp: 6 Fasting
  Rec'd: 4 Weight: 142 lbs
Sample Type
Test
Reported
Time/Date
Initials
DD
Urine
08:05
13-Apr-2007
NS
12-Apr-2007
Heam
08:05
13-Apr-2007
NS
12-Apr-2007
Hbalc
08:05
13-Apr-2007
NS
12-Apr-2007
Chemistry
08:05
13-Apr-2007
NS
12-Apr-2007
Lipid
P
NS
12-Apr-2007
Storage        
Test
Reported
Time/Date
Initials
DD
Urine
13:15
20-Apr-2007
NS
19-Apr-2007
Heam
13:15
20-Apr-2007
NS
19-Apr-2007
Hbalc
13:15
20-Apr-2007
NS
19-Apr-2007
Chemistry
13:15
20-Apr-2007
NS
19-Apr-2007
Lipid
P
NS
19-Apr-2007
Storage        
Test
Reported
Time/Date
Initials
DD
Urine
10:30
30-Apr-2007
NS
30-Apr-2007
Heam
10:30
30-Apr-2007
NS
30-Apr-2007
Hbalc
10:30
30-Apr-2007
NS
30-Apr-2007
Chemistry
10:30
30-Apr-2007
NS
30-Apr-2007
Lipid
P
NS
30-Apr-2007
Storage        
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