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Humanitarian Use Device Sample Only (revised 11/14/19) Cannot be used without IRB Approval TITLE: Name of Humanitarian Use Device PHYSICIAN: Name Address OTHER PHYSICIAN(S): Name(s) 1. INTRODUCTION:

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What is sample only revised 111419?

Sample only revised 111419 refers to a specific form or document that has been updated as of November 14, 2019, intended for reporting or compliance purposes.

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Information typically required on sample only revised 111419 includes entity identification details, specific data points relevant to the reporting criteria, and any additional information mandated by the regulation.