PROTOCOL SPECIFIC MATERIALS
PROTOCOL 6668 Data Forms

Instructions:
 
Study Forms for Protocol 6668
 
Forms Revisions Notices:
 
Study Forms Index:
 
Case Report Form Set:
 
DATA FORMS
 
Registration/Enrollment:
A0        Eligibility Checklist and Registration Questions
Initial Evaluation Form
   
Pre-Treatment Imaging:
PET Technical Assessment Form
Local PET Semi-Quantitative Assessment Form
 
Post-Treatment Imaging:
PET Technical Assessment Form
Local PET Semi-Quantitative Assessment Form
 
Treatment Forms:
Chemotherapy Summary Form
Radiotherapy Summary Form
 
Pathology:
Pathology Submission Form
 
Follow-up Form:                                              Instructions:
F1        Follow-up Form                          F1 Completion Guidelines
F2          PET Imaging Pre and Post Treatment  

End of Study Form:                                         Instructions:
DS        End of Study Form                              DS Completion Guidelines
 
Additional Forms             
AE          Adverse Events Form
Protocol Variation Form
Upstaging Form
Supplemental Payment Form

For additional information regarding Adverse Events,
please visit ACRIN’s Protocol Development and Regulatory Resources page: