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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:
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
Samples Clinical History
DSR: 02-Nov-2007 Exp: 6 Fasting
  Rec'd: 4 Weight: 185 lbs
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
Time/Date
Urine
12:01 02-Nov-2007
NS
01-Nov-2007
Heam
12:01 02-Nov-2007
NS
01-Nov-2007
Hbalc
12:01 02-Nov-2007
NS
01-Nov-2007
Chemistry
12:01 02-Nov-2007
NS
01-Nov-2007
Lipid
P
NS
01-Nov-2007
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