Concomitant Medication
If 'YES', please record all medications used below. Where appropriate, medical conditions should be recorded on the Adverse Experiences Form, utilzing the same terminology. If a medication has had a dosage change it must be recorded with the start and stop date.
boolean
(Trade Name Preferred)
text
Single Dose/Unit
text
Frequency of this Dose
text
Other routes may be entered onto the form when appropriate, and will be coded prior to data entry.
text
Indication
text
day month year As a minimum the year must be stated.
date
00:00-23:59
time
day month year
date
00:00-23:59
time
Continuing at end of study
boolean