피험자 청구서

임상시험 의무기록 열람 신청서 1. 연구과제명 차트번호 성명 연번 차트번호 연구책임자 : 연 번 성명

<caption id="caption17" class="cell_1" style="left:187px; top:35px; width:435px; height:20px; text-align:center; ">과 제 명</caption>
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			<caption id="caption29" class="cell_1" style="left:25px; top:35px; width:160px; height:20px; text-align:center; ">과제번호</caption>
			<caption id="caption3" style="left:0px; top:105px; width:147px; height:34px; font-size:14pt; font-weight:bold; ">2. 신 청 자</caption>
			<input id="input9" ref="/root/main/repdetl/R0274005" navindex="2" style="left:221px; top:164px; width:100px; height:19px; "/>
			<caption id="caption11" class="cell_1" style="left:85px; top:138px; width:135px; height:24px; text-align:center; ">소   속</caption>
			<caption id="caption12" class="cell_1" style="left:221px; top:138px; width:100px; height:24px; text-align:center; ">성 명</caption>
			<input id="input10" ref="/root/main/repdetl/R0274004" navindex="1" style="left:85px; top:164px; width:135px; height:19px; "/>
			<caption id="caption13" class="cell_1" style="left:322px; top:138px; width:159px; height:24px; text-align:center; ">연락처</caption>
			<input id="input12" ref="/root/main/repdetl/R0274006" navindex="3" style="left:322px; top:164px; width:159px; height:19px; "/>
			<caption id="caption14" class="cell_1" style="left:482px; top:138px; width:135px; height:24px; text-align:center; ">비고</caption>
			<caption id="caption15" class="cell_1" style="left:25px; top:138px; width:59px; height:24px; text-align:center; ">연 번</caption>
			<input id="input13" ref="/root/main/repdetl/R0274007" navindex="4" style="left:482px; top:164px; width:135px; height:19px; "/>
			<input id="input19" ref="/root/main/repdetl/R0274003" disabled="true" style="left:25px; top:164px; width:59px; height:19px; text-align:center; "/>
			<caption id="caption16" style="left:0px; top:200px; width:147px; height:34px; font-size:14pt; font-weight:bold; ">3. 열람목적</caption>
			<textarea id="textarea3" ref="/root/main/repdetl/R0274008" navindex="5" scroll="autovscroll" style="left:25px; top:232px; width:595px; height:54px; text-align:left; vertical-align:top; "/>
			<caption id="caption18" style="left:0px; top:305px; width:216px; height:34px; font-size:14pt; font-weight:bold; ">4. 열람 피험자 리스트</caption>
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