Section 2 Laboratory Medicine Test Request Completed by Researcher Research Total Number of Real Time Only state the Tests and Services Per Patient Research Samples Standard or Batch Required at STH Lab Med: Tests & Services Required care Analysis For number per patient Per Patient ( R or B ) 1. Lists all the tests required at STH (see X appendix 1&2 for common Chemistry indicate cost type recruitment target e.g. Urea and Electrolytes 3 4 (RES) 4 x Recruitment Target R profile & test information). 1 (RES) + e.g FBC 0 1+2 x Recruitment Target R 2. State the number of tests per patient 2 (SVC) that are either Standard care or Research 3. For non-commercial studies indicate cost type in brackets: see e.g. Non Commercial: Research Test (RES), Service Cost (SVC), Excess Treatment Costs (ETC) 4. For each test state the total number of research tests during the study if you achieve the recruitment target. 5. State whether samples will be sent to Labs in Real Time (on the day of collection) or require Labs to analyse a Batch of samples that the study have previously stored frozen (if batch analysis is required state the maximum number of samples). If any Additional Services are Required please describe below:
Section 2 Completed by Researcher Laboratory Medicine Test Request Only state the Tests and Services Required at STH Lab Med: 1. Lists all the tests required at STH (see appendix 1&2 for common Chemistry profile & test information). 2. State the number of tests per patient that are either Standard care or Research 3. For non-commercial studies indicate cost type in brackets: see e.g. Non Commercial: Research Test (RES), Service Cost (SVC), Excess Treatment Costs (ETC) 4. For each test state the total number of research tests during the study if you achieve the recruitment target. 5. State whether samples will be sent to Labs in Real Time (on the day of collection) or require Labs to analyse a Batch of samples that the study have previously stored frozen (if batch analysis is required state the maximum number of samples). Tests & Services Required Standard care Per Patient Research Per Patient For indicate cost type Total Number of Research Samples number per patient X recruitment target Real Time or Batch Analysis ( R or B ) e.g. Urea and Electrolytes 3 4 (RES) 4 x Recruitment Target R e.g FBC 0 1 (RES) + 2 (SVC) 1+2 x Recruitment Target R If any Additional Services are Required please describe below: