CHECK FOR STUDY CONTINUATION
Check for Study Continuation
boolean
If No, please record ONE most appropriate reason and skip the following forms of this visit.
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HEMATOLOGY / BIOCHEMISTRY
HEMATOLOGY
Result
float
Result below
integer
Result below
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White Blood Cells
text
Result below
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Result below
integer
Result below
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Result below
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Result below
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Result below
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BIOCHEMISTRY
BUN
float
Result below
float
Result below
float
Result below
float
Cholesterol
float
Creatine phosphokinase
float
Serum Haptoglobin
float
Please complete the following informationwith LDH isoenzymes if the grade 2 or greater LDH is observed (> 1.5 ULN)
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LDH
Result
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Result
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Result
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Result
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Result
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Blood Sample for Immunogenicity Assays
boolean
Date
date
URINALYSIS
Urinalysis (Dipstick) Test
Result
integer
Proteins (via dipstick)
text
Glucose (via dipstick)
text
Ketones (via dipstick)
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Blood and myoglobin (via dipstick)
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Bilirubin (via dipstick)
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Urobilinogen (via dipstick)
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Nitrites (via dipstick)
text
Leukocyte esterase (via dipstick)
text
Urina Sample for Diagnostic Sssay?
boolean
Date
date