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pdfHave 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
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SEARCH 3 Registry Study - Medications Inventory Form – 11-01-10
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9
8
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6
! Yes
! Yes
! Yes
! Yes
! No
! No
! No
! No
Data Entry
Code
Reviewer Code
Completed by
FOR STUDY USE ONLY
Year
Year
Year
! No
Day
Day
Day
! Yes
Month
Month
Month
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Date
Completed
Date
Reviewed
Date
Entered
SEARCH 3 Registry Study - Medications Inventory Form – 11-01-10
File Type | application/pdf |
File Title | 4a1_medication inventory registry.pdf |
Author | arp5 |
File Modified | 2014-05-05 |
File Created | 2014-05-05 |