| Question | Response |
|---|---|
| Specimen | |
| Date of last dose of study drug before sampling | |
| Time of last dose of study drug before sampling | |
| Date of dosing of study drug on the day of sampling | |
| Time of dosing of study drug on the day of sampling | |
| Scheduled sampling time | pre-dose 0.25h 1h 2h 4h |
| Schedule sampling not done? | |
| Date sample taken | |
| Time sample taken | |
| Comments |