Questionnaires - Genesis Builder

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<div style="background-color: #314158; text-align: center; color: white;"><br /><h2 style="text-align: center;">Confirmation of&nbsp;Screen Fail<br /><span class="keyword" contenteditable="false">Sponsor</span> <span class="keyword" contenteditable="false">Protocol</span><br /><br /></h2></div><div style="border-bottom: 4px solid #5c6b7d; background-color: #f5f6f7;"><br /><table style="width: 100%; background-color: #f5f6f7;"><tbody><tr><td><div style="margin-left: 15px;"><img src="http://Genesislogin.Genesislcloud.net/Content/Images/GenesisLogo.png" alt="Logo" width="110" height="50" /></div></td><td><table style="float: right;" align="right"><tbody><tr><td style="color: #6c769b;">User Name:</td><td><span class="keyword" contenteditable="false">UserName</span></td></tr><tr><td style="color: #6c769b;">System Transaction Date:</td><td><span class="keyword" contenteditable="false">SystemDate</span></td></tr><tr><td style="color: #6c769b;">Site Transaction Date:</td><td><span class="keyword" contenteditable="false">LocalDate</span></td></tr></tbody></table></td></tr></tbody></table></div><div style="clear: both; text-align: center;"><table style="margin: 0 auto; width: 700px;" cellspacing="5" cellpadding="4"><tbody><span class="keyword" contenteditable="false">VisitQuestionnaireConfirmation</span></tbody></table><br /><strong><br />Note: </strong>This <span class="keyword" contenteditable="false">PatientLabel</span> has been screen failed and is out of the study.<hr style="border-width: 1px 0px 0px 0px; border-style: inset;" /></div><div style="background-color: #5c6b7d; color: white; text-align: center;"><br /><div>Genesis &copy; <span class="keyword" contenteditable="false">YYYY</span> - Please contact Genesis Support for assistance at Genesis.com/support</div></div>

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Sponsor Protocol Confirmation of Screen Fail - Site SiteID - PatientLabel SubjectNumber

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