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STUDY DRUG ACOUNTABILITY LOG
PRINCIPAL INVESTIGATOR_______________________
Clinical research Coordinator_____________________
Protocol name and/or Number_____________________
Name of the Study Drug__________________________
Subject
ID#
and/or
initials
Lot or
Kit
Number
#
Bottles,
Vials,
etc.
Amount
of study
Drug per
bottle,
Vial, etc.
Total
Amount
Dispens
ed
Initials
Date
Date
Dispensed returned
#of
Total
Balance:
Bottles,
amount
Number
Vials,
returned Dispensed
etc.
Less
Returned
Number
returned
Comments:
Subject lost,
discarded
Initials
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