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98110 Appendices

1. Data Submission Checklist
2. Eligibility Checklist/Registration Form
3. Performance Status Criteria
4. Patient Medication Diary
5. MedWatch
6. Flow Sheet TAS Addendum
7. Study Parameters Table
8.  International Index of Erectile Function*
9.  Sexual Encounter Profile (SEP)* 
10.  Expanded Prostate Cancer Index Composite (EPIC-26) Short Form* 
11.  Global Efficacy Questions* 
    
12. Telephone Contact Form
13. Current Medication Form
14. Patient Recruitment Letter
15. Patient Flyer
16. FACT-P*

*1.To obtain these copyrighted forms, please enter CCRBIS.
 2. Click on “login CCRBIS” at the top right of the CCRBIS screen.
 3. Type Username and Password.
 4. Click on “login.”
 5. Click on “Information” on the left side of the green bar at the top of the page.
 6. Use the 98110 drop-down box on the right to choose the form.
 7. Click on “98110 Forms” at left.
 8. Print.
Contact June Fletcher-Steede at jsteede@wfubmc.edu for password information.

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