Clinical Data Management Edit Check Log Form
Log and track edit checks, discrepancies, and resolutions for clinical study data.
Study Name
*
Site/Center ID
*
Subject/Record ID
*
Visit Name/Number
Edit Check Type
*
Please Select
Data Range Check
Missing Data
Inconsistent Data
Protocol Deviation
Other
Description of Discrepancy
*
Date Discrepancy Identified
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Query/Action Status
*
Please Select
Open
Under Review
Resolved
Closed
Resolution Details
Date Resolved
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Logged By (Initials or Name)
*
Submit Log Entry
Should be Empty: