Pharmacy Self-Evaluation Form

The Pharmacy Self-Evaluation Form must be submitted if the investigator is asking for an exemption to dispense experimental drugs for a particular protocol without requiring the services of the MUHC Pharmacy department. Such a request for an exemption is only possible for research protocols which are conducted with out-patients for whom experimental drugs are given to the user in the original container, labelled by the manufacturer. The Pharmacy Self-Evaluation Form must be accompanied by a copy of the protocol, the Investigator Brochure, and a sample of the study drug container and label which will be returned to you.

Pharmacy Self Evaluation English form [doc]    Pharmacy Self Evaluation English form [pdf]
Pharmacy Self Evaluation French form [doc]   Pharmacy Self Evaluation French form [pdf]

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