Electrocardiogram (12 Lead)
12 lead ECG, Date in time
date
If ’Yes’, please record details in the Baseline Signs and Symptoms and/or SAE section at the back of this book and exclude the patient from the study.
boolean
Physical Examination
Laboratory Evaluation
Collection of blood specimen for laboratory procedure, Date in time
date
Laboratory Procedures, Laboratory specimen identification label
text
If ‘Yes’, please record the findings and/or diagnosis in the Baseline Signs and Symptoms and/or SAE section at the back of this book and exclude the patient from the study.
boolean
Urine Dipstick
If ’Positive’, please record details on the Significant Medical/Surgical History and Physical Examination or Baseline Signs and Symptoms/SAE pages and send a sample to Quest Diagnostics for further evaluation.
text