Drug, Biologic, Nutritional Supplement, & Substance Table Printed on 5/31/2018 4:38:09 PM

Study Short Name:

List any specifically-named drug, biologic, nutritional supplement, substance, or any other ingested/applied substance required by the protocol OR provided/paid for by the sponsor. There is no need to include items merely suggested or recommended unless they are to be paid for by the sponsor. Sponsor-funded pre-meds or concomitant meds obtained from a non-investigational pharmacy can be listed generically as long as you have a Confirmation of Services from the applicable pharmacy that acknowledges that these drugs will be invoiced to the study.

Note: A Confirmation of Services is REQUIRED for any item that is billed to/provided by the Sponsor AND that is stored or administered in a location marked with “*”. Contact Investigational Drug Services at 352-265-0404 Ext. 44716 for more information on both investigational AND non-investigational pharmacies. FDA Drug Type Funding Source Administration Name of Item (choose from drop FDA IND# (choose from drop Storage Location Use of Item Location down) down)

Use of Item Key: Conditional: Items required by protocol for SOME subjects in SOME circumstances (e.g. Adverse Event, lab results etc.) All Subjects: Items required by protocol for ALL subjects ( including items that are randomized.) Out of space? Unprotect this document and add rows. Comments:

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