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CTC STUDY ENROLLMENT FORMS
LISTED BELOW ARE THE FORMS NEEDED PRIOR TO SCHEDULING PATIENTS WITH CTC.

Protocol--The research investigator/coordinator must provide CTC and Pharmacy with a copy of the protocol.

Consent form--A copy of the HRRC-approved consent form.

HRRC approval letter--A copy of the HRRC (Human Research Review Committee) approval letter.

CTC Calculation Sheet--Original calculation sheet signed by the Research Investigator and CTC Manager.

Referral Billing Account Number--This account number from UH Accounting Department is needed before any study needing Bone Densitometry begins in the CTC. Rod from Accounting will be able to assist you in obtaining this number. His extension is 272-0252. If you do not have a referral billing account number, a CTC Referral Billing Questionnaire is available to complete and return to him.

Purchase Order--This account number is from the School of Medicine Controller's Office. A purchase order from the investigator's department to the Clinical Trials Center in the amount of $5,000.00 for research services. A copy of the purchase order needs to be on file in the CTC prior to the study starting.

Note: Once the CTC has received all of the aforementioned forms, patients may be scheduled 72 hours in advance. "I have read the above requirements, on pages 1 through 4, to utilize the CTC and agree to abide by them."

Signature of Primary Investigator:

Date:
Signature of Study Coordinator:

Date:
Revised: 4/97

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