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Research and Innovation: Office of Research Regulatory Affairs

Screening-Enrollment Log

 Study IDGenderEthnicityRaceDate Subject Signed Consent*Copy of Signed/Dated Consent Given to Subject (Yes/No)Subject Eligible?(Yes/No)If Not Eligible, Reason for ExclusionSubject Final Status**
(C, CW, WD, SF)		Comments
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* An ‘enrolled’ subject is one who has signed a consent form.
** C: completed participation / CW: consent withdrawal / WD: withdrawn / SF: screen fail