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Telephone: +859 781 8877 Fax: +859 781 9310
Email: support@ppdi.com
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Call Log
Specification Sheet
Current User: Shelly Smith (ssmith01) Last Login: 08:59 06-Dec-2007
Incoming Call Summary
Current User:
Shelly Smith
Length of Call:
4 min 53 sec
Time/Date Call Received:
09:05 06-Dec-2007
Caller Name:
James Mills - Monitor
Caller Phone:
555-555-5678
Caller Fax:
555-555-2323
Caller Email Address:
jamesmills@monitor.com
Protocol Number:
12321
Study Number:
10001
Site Number:
101
Site Mailing Address:
1234 Main Street, New Hope, MN 55428-3623
Site Phone:
763-404-1443
Site Fax:
763-553-9796
Site Email:
abccompany@somewhere.com
Resident #1 Screening ID:
100001
Resident #1 Randomization ID:
123456
Resident #1 Accession ID:
888888
Resident #1 Initials:
AAA
Resident #1 DOB:
12-Nov-1973
Resident #1 Gender:
Male
Reason(s) for Call:
- Correction made to
Resident Initials
: From 'AAD' to 'AAA'
- New
Site phone number
assigned: From '763-489-6149' to '763-404-1443'
-
DSR Visit 1
re-sent to Fax 763-235-2323 and Additional Fax 763-553-9796
Additional Comments:
Additional comments entered here...
Resident #2 Screening ID:
100002
Resident #2 Randomization ID:
999956
Resident #2 Accession ID:
777777
Resident #2 Initials:
RTG
Resident #2 DOB:
01-Jan-1965
Resident #2 Gender:
Male
Reason(s) for Call:
-
DSR Visit 1
re-sent to Fax 763-235-2323 and Additional Fax 763-553-9796
Additional Comments:
Additional comments entered here...
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