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    Rakshitha
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    This document is a completion/termination form for a clinical trial subject. It records the date that the subject completed or terminated from the trial. It identifies the primary reason for completion or termination, such as normal protocol completion, an adverse event, loss to follow up, or sponsor termination. The form requires the investigator's signature and date to certify that all case report forms for this subject are complete and accurate.

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    This document is a completion/termination form for a clinical trial subject. It records the date that the subject completed or terminated from the trial. It identifies the primary reason for completion or termination, such as normal protocol completion, an adverse event, loss to follow up, or sponsor termination. The form requires the investigator's signature and date to certify that all case report forms for this subject are complete and accurate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2 views1 page

    CRF Edited

    Uploaded by

    Rakshitha
    This document is a completion/termination form for a clinical trial subject. It records the date that the subject completed or terminated from the trial. It identifies the primary reason for completion or termination, such as normal protocol completion, an adverse event, loss to follow up, or sponsor termination. The form requires the investigator's signature and date to certify that all case report forms for this subject are complete and accurate.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    TADALAFIL Subject Number:

    Subject Initials:
    Protocol Number: NCT01862536 Site Number:

    COMPLETION/TERMINATION FORM

    Date of Completion or Termination

    D D MMM YYY Y

    Check primary reason for completion or termination. Please indicate only one.

    1. Normal protocol completion.


    2. Developed an adverse event, specify:
    3. Lost to follow up.
    4. Research terminated by Sponsor.
    5. Date (report to sponsor; complete serious adverse event form).
    6. Date of death:
    7. Other, explain:

    I certify that I have examined all case report form for this subject and found them to be
    complete and accurate.

    Investigator’s signature Date

    DD/MM/YYYY

    Version Number: 1, 13th April 2023

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