Consortium Protocol #: Other Identifier: Research Coordinator (Required) Back-Up Coordinator/Contact (Required) Name Name: Phone: Phone: Pager: Date of Specimen Collection Study Drug Dosing Date: Day of the Week: Day of Week: Projected Dose Time: Patient ID Time Frame In Which Specimens Must Be Processed Following Collection * * *To Ensure This Time-Frame is Met, Transport Must Be Done by Research Staff Special Processing Instructions: FOR SPECIMEN PROCESSING STAFF ONLY True Specimen Pick-up Specimen Specimen Processing Processing Start Time Time Comments Type Location Collection Projected Location Indicator Time Specimen 1100 Blood, If applicable, please indicate Who will Number of Collection Eastlake Time Specimen Placed In Cycle/day, Marrow, why specimen was processed Tubes Courier? Time or Urine, Pre, 1 Hr Freezer out of window Processed C = Courier SCCA Etc. Post, etc RS = Research F= Frozen A = Ambient E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS E1 G7 F/A C RS PLEASE NOTE: ON SPECIMEN COLLECTION DAY - PLEASE CONFIRM ACTUAL DOSE TIME WITH SPECIMEN PROCESSING LAB 667-4645 (1100 Eastlake) or 288-1134 (SCCA) Rev. 01-2017
Consortium Protocol #: Other Identifier: Research Coordinator (Required) Back-Up Coordinator/Contact (Required) Name Phone: Pager: Name: Phone: Date of Specimen Collection Study Drug Dosing Date: Day of Week: Day of the Week: Projected Dose Time: Patient ID Time Frame In Which Specimens Must Be Processed Following Collection * * *To Ensure This Time-Frame is Met, Transport Must Be Done by Research Staff Special Processing Instructions: FOR SPECIMEN PROCESSING STAFF ONLY Projected Specimen Collection Time Specimen Type Blood, Marrow, Urine, Etc. Specimen Time Indicator Cycle/day, Pre, 1 Hr Post, etc Pick-up Location Processing Location 1100 Eastlake or SCCA True Specimen Collection Time Processing Start Time Comments If applicable, please indicate why specimen was processed out of window Who will Courier? C = Courier RS = Research Number of Tubes Processed Time Specimen Placed In Freezer F= Frozen A = Ambient E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A E1 G7 C RS F/A PLEASE NOTE: ON SPECIMEN COLLECTION DAY - PLEASE CONFIRM ACTUAL DOSE TIME WITH SPECIMEN PROCESSING LAB 667-4645 (1100 Eastlake) or 288-1134 (SCCA) Rev. 01-2017
Research-Specimen-Scheduling-Template-01-2017.docx