CLINICAL RESEARCH AUDIT TEMPLATE

MEDICAL RECORD NO.	ADMISSION DATE
OVERSEEING PHYSICIAN NAME
REVIEWED BY	DATE OF REVIEW
RESEARCH, EXPERIMENTS, AND TRIALS	IS THIS APPLICABLE?	DOCUMENTATION PRESENT
YES	NO	YES	NO
PATIENT CONSENT OF PARTICIPATION
DESCRIPTION OF EXPECTED BENEFITS
DESCRIPTION OF POTENTIAL RISKS
DESCRIPTION OF ALTERNATIVE PROCEDURES
EXPLANATION OF CURRENT PROCEDURE
CONSENT FORMS SIGNED
PATIENT'S RIGHT TO PRIVACY AND CONFIDENTIALITY
PROCEDURE MATCHES THE CONSENT FORM
IF "NO" SELECTED FOR ANY ITEM, PLEASE EXPLAIN:

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