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Appendices

1. Data Submission Requirement Form - TAS - Addenda
2. Eligibility Checklist
3. Performance Status Criteria
4. Medication Diary
5. Medwatch
6. Data Submission Schedule
7. Study Parameter Table
8. Baseline Booklet*
9. Week 12 Booklet*
10. Week 24 Booklet*
11. Week 36 Booklet*
12. Perceived Cognitive Impairment Questionnaire and Score Sheet*
13. Telephone Contact Sheet
14.  Participant Screening Form
15. Current Medication Form
16. Early Withdrawal Form

Combined Appendices*

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 97211 drop-down box on the right to choose the form.
 7. Click on “97211 Forms” at left.
 8. Print.
Contact June Fletcher-Steede at jsteede@wakehealth.edu for password information.