Download:
pdf |
pdf Have you taken in last 2 days?
Rosiglitazone (Avandia) ....................
Repaglinide (Prandin) .......................
Pioglitazone (Actos)..........................
Glyburide (Micronase, Diabeta,
Glynase) .........................................
Glipizide (Glucotrol) ……………………….
Glimepiride (Amaryl) ……………………..
Acarbose (Precose, Prandase) ………..
Metformin (Glucophage) …………………
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
(Check yes or no)
Rosglitazone/Metformin (Avandamet)
Yes
Oral Medications for diabetes
Nateglinide (Starlix) .........................
2
1
Yes
Yes
Yes
No
No
No
No
Have you taken in last 2
days? (Check yes or no)
3
Yes
No
Other Medications (including diabetes medications not listed above)
4
Yes
Page 2 of 3
5
SEARCH 3 Registry Study - Medications Inventory Form – 11-01-10
(Continue to next page)
9
8
7
6
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Data Entry
Code
Reviewer Code
Completed by
FOR STUDY USE ONLY
Year
Year
Day
Year
Day
Month
Day
Month
Month
Page 3 of 3
10
Date
Completed
Date
Reviewed
Date
Entered
SEARCH 3 Registry Study - Medications Inventory Form – 11-01-10
| File Type | application/pdf |
| File Title | Microsoft Word - Registry Medicatons Inventory revised_03-08-07_11-01-10 FINAL FINAL |
| Author | stmoxley |
| File Modified | 2011-05-10 |
| File Created | 2010-10-29 |