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_Lecture notes_audit_form_04-25-06

_Lecture notes_audit_form_04-25-06 - UNIVERSITY OF...

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Date of Audit: __________ Reviewed by: ______________ Patient ID: _______________ Site: ________________ ___ Site Contact: __________ _ Treatment Arm: __________ Date on Study: ___________ Off Study: __ _ Yes ___ No Baseline Only : ____ Yes ____ No CRITERIA EVALUATION YES NO N/A 1. Is the patient eligible according to protocol criteria? 2. Consent signed prior to and treatment? 3. Randomization administered correctly? 4. Educational sessions took place in specified time frame? 5. Follow-up according to protocol? 6. Hard copies matched data entry copies? 7. If patient is off study, is data collection complete? FINAL ASSESSMENT: Met Requirements Discrepancies Noted Protocol Violation (all marked yes) (those marked no were noted) (answer of no without notes) NOTE: All responses other than "YES" require a written explanation to accompany this form Auditor Signature ______________________________ Date___________________ Project Administrator Signature ______________________________ Date__________________ UNIVERSITY OF CALIFORNIA DAVIS CANCER CENTER SIMULTANEOUS CARE: Linking Palliation to Clinical Trials DR. FRED MEYERS Grant# CA95260
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  • Winter '06
  • Tsodikov
  • data entry, Clinical trial, Informed consent, data entry copies, data collection complete, Simultaneous Care Patient

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_Lecture notes_audit_form_04-25-06 - UNIVERSITY OF...

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