DRUG ACCOUNTABILITY LOG

Principal Investigator:	HRC Protocol #:

Sponsor:

Drug Name:	Drug dose form:	Strength:

Subject Initials	Subject ID	Lot #	Kit/

Bottle #	Date Dispensed	Quantity Dispensed	Dispensed by	Balance/

Inventory forward	Date Returned	Quantity Returned	Returned To

Principal Investigator Signature:	Date:

Human Research Quality Improvement Program

Partners HealthCare System, Inc. All Rights Reserved May 2008

DRUG DISPENSING LOG

Partners Information Systems

2014-05-15

Partners HealthCare System