Clinical Trial Review for Emory Medical Laboratory Services

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Clinical Trial Review for Emory Medical Laboratory Services
Does your study require tests in the Clinical Laboratory? Yes
complete form below.)
No
(If yes, please
Clinical Trial: Click here to enter text.
Principal Investigator: Click here to enter text.
Start Date: Click here to enter text.
End Date: Click here to enter text
Study Coordinator: Click here to enter text.
Grant Acct. Number (Smartkey): Click here to enter text
1. Coordinator Fee Schedule Review:
Please contact [email protected] for a research fee pricing.
2. Location of study subjects? Click here to enter text.
3. Samples drawn by:
Lab
Study Nurse
indicate special collection requirements, i.e. timed study.)
Click here to enter text.
4. List Labs to be included:
or other?
(If yes for Lab,
Click here to enter text.
a. Labs sent to a central lab or performed by EML?
b. Referral testing required?
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Yes
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No
(If yes, explain)
5. Is the sponsor requiring any special or particular lab methods to be used? If so please elaborate.
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6. Special Processing required?
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Yes
No
(If yes, explain)
7. Special reporting required?
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Yes
No
(If yes, explain)
8. Contact for critical result reporting? (Must be available 24x7)
If questions, please contact Lynne McClure (404) 712-7373
9 February 2016
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