Medical Study Checklist
Document and track study procedures, participant information, and compliance for clinical research.
Participant Full Name
*
First Name
Last Name
Participant Email Address
*
example@example.com
Participant Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Study Name or ID
*
Date of Checklist Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Study Procedures Checklist
*
Rows
Completed
Not Applicable
Informed Consent Obtained
1
2
Eligibility Criteria Met
3
4
Baseline Assessment
5
6
Intervention Administered
7
8
Follow-up Visit
9
10
Lab Samples Collected
11
12
Were there any adverse events?
*
No
Yes (please describe below)
If yes, describe adverse events
Compliance Confirmation
*
All procedures completed as per protocol
Deviations occurred (please describe below)
If deviations, describe
Investigator/Clinician Name
*
Participant Signature
*
Submit Checklist
Submit Checklist
Should be Empty: