**Form OTIMM-2: Chemical Use Log for Clinical Trials Using**

**Terramycin 343^7^under INAD 9033**

**[INSTRUCTIONS]{.underline}**

1\. Investigator should initiate a [new]{.underline} form OTIMM-2
**[immediately]{.underline}** upon receipt of each shipment of
Oxytetracycline for Immersion.

2.  Form OTIMM-2 should be updated whenever drug is used, transferred,
    or discarded.

3\. Investigator should save all copies of this form until the end of
the calendar year, at which time they should maintain all originals on
file and send one copy of the completed form(s) to their Study Monitor.
Within 10 days of receipt, the Study Monitor will ensure accuracy and
send a copy to the AADAP Office for inclusion in the permanent file.

4.  **[Note:]{.underline}** Both Investigator and Study Monitor should
    sign and date Form OTIMM-2.

Qty of OTIMM from Reporting

**previous page (gm) Facility individual**

+-----+------+------+------+-------+--------+------+--------+-------+
| **  | **Am | *    | **S  | **A   | **     | **TM | **     | *     |
| Dat | ount | *Lot | tudy | mount | TM-343 | -343 | TM-343 | *Inve |
| e** | of   | nu   | Numb | of    | trans  | d    | rem    | ntory |
|     | new  | mber | er** | TM-   | ferred | isca | aining | by    |
|     | TM   | of** |      | 343** | (gm)** | rded | on     | (I    |
|     | -343 |      |      |       |        | (g   | hand   | nitia |
|     | rece | **TM |      | *     |        | m)** | (gm)** | ls)** |
|     | ived | -343 |      | *used |        |      |        |       |
|     | (g   | re   |      | in    |        |      |        |       |
|     | m)** | ceiv |      | trea  |        |      |        |       |
|     |      | ed** |      | tment |        |      |        |       |
|     |      |      |      | (     |        |      |        |       |
|     |      |      |      | gm)** |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     |      |      |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+
|     | **xx | **xx |      |       |        |      |        |       |
|     | xx** | xx** |      |       |        |      |        |       |
+-----+------+------+------+-------+--------+------+--------+-------+

  ------------- ----------------- ------------------- ---------------------------
  **Date                          **Investigator:**   
  Prepared:**                                         

  **Date                          **Study Monitor:**  
  Reviewed:**                                         
  ------------- ----------------- ------------------- ---------------------------