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Application Forms l 2IRS l 2IRS(2)
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Shipment of clinical trial Investigational products

by using the D2M SANTE/ CSP 2 IRS System
PLEASE ANSWER THE FOLLOWING:

 
Clinical trial Number/code:
Site N°:

Investigator’s name

for the above site:


• The patient to be included in the clinical trial meets the inclusion/exclusion criteria
    Yes No

• Stratification
    Yes No    if yes, please specify the stratum number:

• I have already sent the inclusion supportive documents for the concerned patient
    Yes No

Warning : The inclusion supportive documents for the concerned patient are to be sent without any delay:
by fax to the following N°: 04 73 69 89 44
to the following e-mail address: carfeuil @csp-epl.com