Trial Personnel Signature Form - MMCRI
Trial Title: | Site: | |
| | Site PI: |
|Trial Number: | |
| | | | |
|NAME (printed) |SIGNATURE |STUDY RESPONSIBILITIES (CODE) |INITIALS AND |DATE STARTED WITH TRIAL|DATE ENDED WITH TRIAL |PI INITIALS |
|and Title | | |DATE | | |DATE |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|A = Subject enrollment decision |D = Perform study assessments |G = Investigational product | |
| | |management | |
|B = Obtain informed consent |E = Principal Investigator |H = CRF entries/corrections | |
|C = Medical care of subjects |F = Prescribe investigational product |I = Other (please note) | |
| |
| |
|PI Signature: _________________________________ Name Printed: _________________________________ Date _____________ |
Please have a Principal Investigator initial each entry to verify the privileges listed.
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