***Issue***
1.1
Visit number
1.2
Issue date
1.3
Investigational product
1.3.1
Describe investigational product
Only shown if field 1.3 is equal to Other
1.4
Batch number
1.5
Number of products issued
1.6
Expiration date
1.7
Issued by
1.8
Issue checked by
***Return***
1.9
Was investigational product returned?
1.9.1
Explain why the product was not returned
Only shown if field 1.9 is equal to No
1.9.2
Date return product
Only shown if field 1.9 is equal to Yes
1.9.3
Number of product returned
Only shown if field 1.9 is equal to Yes
1.9.4
Received by
Only shown if field 1.9 is equal to Yes
***Destruction***
Before product will be destroyed, two people should check the drug accountability
1.10
Initials check 1
1.11
Initials check 2
1.12
Date of destruction of investigational product
Product
Yes/No