|
ADAPT
FORMS
Click on Form ID acronym
to link to PDF document
|
| Form
ID |
Form
Name |
Date |
Revision |
| KA |
Abridged
Knowledge Assessment |
12
Jul 01 |
2 |
| AC |
Adjudication
Committee Findings |
01
Mar 01 |
1 |
| AE |
Adverse
Event Log |
14
Mar 02 |
2 |
| SP |
Ancillary
Study Proposal |
15
Feb 01 |
1 |
|
BA |
Banking of Serum, Plasma, and Urine |
15 Oct 03 |
1 |
|
BC |
Blood
Collection for DNA Analysis |
27 Aug 03 |
2 |
| BF |
Blood
Specimen Shipment Fax Coversheet |
15
Feb 01 |
1 |
|
BS |
Blood
Specimen Shipment Log |
08 Sep 03 |
2 |
| BT |
Blood
Specimen Tracking Log |
15
Feb 01 |
1 |
|
CB |
Cognitive
Assessment Battery Results |
02 May 03 |
5 |
| CI |
Conflict
of Interest Disclosure Form |
15
Feb 01 |
1 |
|
DD |
Death
Documentation |
28 Apr 03 |
2 |
| DR |
Death
Report |
22
Apr 03 |
1 |
|
DB |
Dementia
Evaluation Battery Results |
18 Jun 03 |
4 |
|
DE |
Dementia
Evaluation Referral |
27 Jan 06 |
1 |
|
DV |
Dementia
Evaluation Visit Summary |
26 Mar 03 |
3 |
| DO |
Drug
Order Form |
14
Mar 02 |
2 |
|
EH |
Eligibility
and Medical History |
17 Aug 04 |
5 |
| EB |
Eligibility
Evaluation Battery Results |
15
Jul 02 |
3 |
|
EF |
Enrollment
Form |
09 Aug 04 |
5 |
| FS |
Field
Site Certification |
15
Jul 02 |
2 |
|
FC |
Field
Site Closeout |
09 Aug 07 |
1 |
|
FH |
Followup
Medical History |
26 Aug 04 |
5 |
|
MC |
Missed
or Incomplete Telephone Contact or DEV Visit |
27 Jan 06 |
1 |
|
MV |
Missed
or Incomplete Visit/Telephone Contact |
02 May 03 |
3 |
| NC |
Neuropsychology
Certification |
17
Jul 02 |
2 |
| NK |
Neuropsychology
Knowledge Assessment |
05
Mar 01 |
1 |
|
CO |
Participant Closeout |
08 Jan 07 |
1 |
| PC |
Personnel
Certification |
14
Mar 02 |
2 |
|
PM |
Proposed Manuscript Information Request |
10 Jan 03 |
1 |
| RG |
Registration
and Participant Location |
14
Mar 02 |
1 |
| DS |
Request
to Destroy DNA Sample |
15
Feb 01 |
1 |
|
SR |
Safety
Report |
09 Aug 04 |
4 |
| SF |
Safety
Report Fax Coversheet |
15
Feb 01 |
1 |
|
SB |
Specimen Bank Registration |
11 Sep 03 |
1 |
| AL |
Study
Drug Accounting Log |
14
Mar 02 |
2 |
| SD |
Study Drug Issue and Return |
26
Sep 02 |
2 |
|
TB |
Telephone
Assessment Battery Results |
13 Apr 06 |
2 |
|
TE |
Telephone
Enrollment |
13 Apr 06 |
2 |
|
TF |
Telephone
Follow-up History |
13 Apr 06 |
2 |
| TS |
Telephone
Screen |
15
Feb 01 |
1 |
| TI |
Study Physician-directed Treatment
Interruption |
14
Mar 02 |
2 |
| TR |
Study Physician-directed Treatment
Reinstatement |
14
Mar 02 |
2 |
| UT |
Unmasking
of Treatment Assignment |
30
Jul 02 |
1 |
|
UW |
UW Specimen Shipment Notification |
30 Jun 06 |
2 |
