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    Concomitant Medication Log: Subject Initials Subject ID# Page of

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    Anusha Denduluri
    This document appears to be a concomitant medication log from a clinical trial or research study. It contains headings for subject initials and ID number, medication or non-drug therapy name, indication, dose, dose units, dosing schedule and frequency, dose form, route of administration, and whether the medication was present at baseline or will continue at the end of the study. The log also includes codes to standardize information about dose, schedule, form, and route of administration for recorded medications.

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    Concomitant Medication Log: Subject Initials Subject ID# Page of

    Uploaded by

    Anusha Denduluri
    13 views1 page
    This document appears to be a concomitant medication log from a clinical trial or research study. It contains headings for subject initials and ID number, medication or non-drug therapy name, indication, dose, dose units, dosing schedule and frequency, dose form, route of administration, and whether the medication was present at baseline or will continue at the end of the study. The log also includes codes to standardize information about dose, schedule, form, and route of administration for recorded medications.

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    ConcomitantMedicationTrackingLog_2016.01.31

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    This document appears to be a concomitant medication log from a clinical trial or research study. It contains headings for subject initials and ID number, medication or non-drug therapy name, indication, dose, dose units, dosing schedule and frequency, dose form, route of administration, and whether the medication was present at baseline or will continue at the end of the study. The log also includes codes to standardize information about dose, schedule, form, and route of administration for recorded medications.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    13 views1 page

    Concomitant Medication Log: Subject Initials Subject ID# Page of

    Uploaded by

    Anusha Denduluri
    This document appears to be a concomitant medication log from a clinical trial or research study. It contains headings for subject initials and ID number, medication or non-drug therapy name, indication, dose, dose units, dosing schedule and frequency, dose form, route of administration, and whether the medication was present at baseline or will continue at the end of the study. The log also includes codes to standardize information about dose, schedule, form, and route of administration for recorded medications.

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    of 1

    HEADER: PI NAME, Protocol or IRB Number, Protocol Short Title

    Subject Initials Subject ID# Page of

    Question: Are you currently taking any medications (prescription, over the counter, vitamins, minerals, supplements), or non-drug therapy?

    Concomitant Medication Log


    Dose Baseline Continuing
    Medication/ (per Dose Schedule/ Dose Route of Start End Med at end of
    # Non-drug Therapy Indication admin) Units1 Frequency2 Form3 Administration4 Date Date (Y/N) study (Y/N)

    Dose Units1 Schedule (frequency)2 Dose Form3 Route of Administration4


    1 - g (gram) 1 - QD (once a day) 7 - QOM (every other mo) 1 - Tablet 7 - Suspension 1 - Oral 8 - Inhalation
    2 - mg (milligram) 2 - BID (twice a day) 8 - QH (every hour) 2 - Capsule 8 - Patch 2 - Topical 9 - Intravenous
    3 - µg (microgram) 3 - TID (three times a day) 9 - AC (before meals) 3 - Ointment 9 - Gas 3 – Subcutaneous 10 - Intraperitoneal
    4 - L (liter) 4 - QID (four times a day) 10 - PC (after meals) 4 - Suppository 10 - Gel 4 - Intradermal 11 - Nasal
    5 - mL (milliliter) 5 - QOD (every other day) 11 - PRN (as needed) 5 - Aerosol 11 - Cream 5 - Transdermal 12 - Vaginal
    6 - IU (International Unit) 6 - QM (every month) 12 - Other 6 - Spray 12 - Powder 6 - Intraocular 13 - Rectal
    7 - Other 7 – Intramuscular 14 - Other

    Form Number: Version Date: 01/31/2016

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