DATA CLARIFICATION FORM
PROTOCOL ID:
SITE CODE
LN/TB/AM/LN18178/18.
DATE QUERY RAISED:
SUBJECT ID
QUERY
PROPOSED
VALUE/QUERY
RESOLUTION
REASON FOR
CHANGE
QUERY
PROPOSED
VALUE/QUERY
RESOLUTION
REASON FOR
CHANGE
QUERY
PROPOSED
VALUE/QUERY
RESOLUTION
REASON FOR
CHANGE
DCF RAISED BY:
DCF RESOLUTION PROPOSED BY:
SIGNATURE:
DATE:
Data Clarification Form; Ver. 01; Dated: 14-Nov-2018
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