Sample Flow Sheet for a Clinical Trial Consent Form

Name of Study: ____________________________________________

Schedule of Study Visits

Stage I

Stage II

Stage III

Procedures

Visit:

1

2

3

4

5

6

7

8

9

10
 

Week:

  

2

4

6

8

10

12

14

16

18

Sign Consent Form

X

                  

Medical History

X

                  

Physical Exam

X

                

X

ECG

X

                

X

Chest X-ray

X

                  

Laboratory Tests*

X

X

    

X

        

X

Questionnaire

X

X

X

X

X

X

X

X

X

X

Routine Clinic Visit**

X

X

X

X

X

X

X

X

X

X

*   Non-fasting

** Routine clinic visits include: measurement of blood pressure, heart rate, and weight.