Form 1 DARF

Drug Accountability Record

DARF

Accountability Record/TID Transfer Form

OMB: 0925-0240

Document [pdf]
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Division of Cancer Treatment and Diagnosis
Cancer Therapy Evaluation Program

National Institutes of Health
National Cancer Institute

OMB No. 0925-0240
Expires: 11/30/2007
NIH-2564

PAGE NO.

…
SATELLITE RECORD …
CONTROL RECORD

Investigational Agent Accountability Record
Name of Institution:

NCI Protocol No.:

Agent Name:

Dose Form and Strength:

Protocol Title:

Dispensing Area:

Investigator Name:

NCI Investigator No.:

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Date

Patient’s
Initials

Patient’s ID No.

Dose

Quantity
Dispensed or
Received

Balance Forward
Balance

Manufacturer
and Lot No.

Recorder’s
Initials


File Typeapplication/pdf
File TitleMicrosoft Word - Agent Accountability 10_23_07 Second Draft.doc
Authorfordm
File Modified2007-10-23
File Created2007-10-23

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