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PROTOCOL SPECIFIC MATERIALS

Recruitment and Educational Materials

6664 Contact Personnel

Participating Sites

Regulatory Resources
Page Link
Protocol Development & Regulatory Resources

PROTOCOL 6664 DATA FORMS

Case Report Form Set:

6664 Annotated CRF Booklet [PDF]

Form Revisions

Form Revision Memo, 11-15-2005

Form Revision Memo, 9-2-2005

Form Revision Memo, 6-9-2005

Form Revision Memo, 5-20-2005
Form Revision Memo, 4-19-2005

Form Revision Memo, 2-28-2005
Form Revision Memo, 2-24-2005

Form Revision Memo, 1-27-2005

C2

Local CTC Interpretation Form

W1

Local CTC Interpretation Worksheet (Lesions 11-20)

Local Colonoscopy/Pathology Form

PC

Pathology Submission Form

PR

Protocol Variation Form

CX

Secondary Reader CTC Interpretation Form

Instructions for Using the RESET/DELETE Button

6664 Case Report Form Set

I1

Initial Evaluation

AE

Adverse Event Case Report Form

WX

Local CTC Interpretation Worksheet

B1

Lesion Photograph Transmittal Form

Central Colonoscopy/Pathology

FX

Extracolonic Findings Form

Local CTC Acquisition Form

W2

Secondary Reader CTC Interpretation Worksheet

CTC Software Questionnaire

Participant Questionnaire for CT Colonography (optional)

Instructions for Entering Data Within the Correct Form and Due Date

Cost Effectiveness Forms:

Confidential Participant Contact Sheet

ES

Participant Coversheet for PQ Form

TM

Time-Motion Form

PQ

Spanish Cost & Acceptability Form

CS

Coversheet for PQ Form

Patient Cost and Acceptability Form

T2

Time-Motion Form

ES

Spanish Participant Cover Sheet for PQ Form

Image Quality Control:

DP

Imaging Transmittal Form

CT Quality Assessment Form

For additional information regarding Adverse Events,

please visit ACRIN’s Protocol Development and Regulatory Resources page:

www.acrin.org/pdrc.aspx [Site Link]

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