A form 310 or IRB letter of approval and an IRB approved consent form must be received by the Research Base Protocol Information Office – Attn: Site Coordinator prior to patient registration. Fax: (336)716-6275 Fill out the appropriate Appendix, “Eligibility Checklist / Registration Form’. Use this to complete the on-line registration. Log on to the CCCWFU Research Base registration web site at https://ccrbis.phs.wfubmc.edu/. Enter your user name and password (which may be obtained by contacting June Fletcher-Steede at jsteede@wfubmc.edu.) In the ‘Patient Registration and Protocol Information’ table, click the ‘Register Patient/Patient Info’, with the corresponding protocol number found in the drop down box to the right. Fill in the eligibility criteria forms using the drop down boxes. If further information is needed by Biologics or Data Management, they will contact you. Once the patient information has been entered online print a copy of the eligibility checklist/registration form for your records. Press the submit button, a confirmation page will appear. Print this confirmation sheet for your records. The CCCWFU On-line Protocol Registration/Eligibility form, the initial flow sheet, signed consent, histology reports, scan reports and lab reports (as required in protocol) should be faxed to 336-713-6476 or mailed to Data Management: Data Management Center
Department of Radiation Oncology
WFUBMC
Medical Center Boulevard
Winston-Salem, NC 27157 |