Study Chart [Example] You will receive [study drug(s) or intervention] every [insert appropriate number of days or weeks] in this study. This [insert appropriate number of days or weeks] period of time is called a cycle. The cycle will be repeated up to [insert appropriate number] times. Each cycle is numbered in order. The chart below shows what will be done during Cycle 1 and future treatment cycles as previously explained. The left-hand column shows the day in the cycle and the right-hand column includes the activities performed on that day. Cycle 1 Day What you do Two days Get routine blood tests. before starting study Day before Check-in to _____________ the evening before starting study. starting study taking ______ once a day. Keep taking _____ until the end of study, Day 1 unless told to stop by the investigator or your regular doctor. Day 2 Leave _______________ and go to where you are staying. Day 8 Get routine blood tests. Day 15 Get routine tests. Day 22 Get routine blood tests. Get routine tests and exams. Day 28 Get 2nd chest x-ray for research purposes. Return to the investigator’s office at _______ [insert appointment time] for Day 29 your next exam and to the next cycle. Future cycles Day What you do Keep taking _____ once a day if you have no bad side effects and cancer Days 1-28 is not getting worse. Call the investigator at _____________ [insert phone
Study Chart [Example] You will receive [study drug(s) or intervention] every [insert appropriate number of days or weeks] in this study. This [insert appropriate number of days or weeks] period of time is called a cycle. The cycle will be repeated up to [insert appropriate number] times. Each cycle is numbered in order. The chart below shows what will be done during Cycle 1 and future treatment cycles as previously explained. The left-hand column shows the day in the cycle and the right-hand column includes the activities performed on that day. Cycle 1 Day What you do Two days before starting study Get routine blood tests. Day before starting study Check-in to _____________ the evening before starting study. Day 1 taking ______ once a day. Keep taking _____ until the end of study, unless told to stop by the investigator or your regular doctor. Day 2 Leave _______________ and go to where you are staying. Day 8 Get routine blood tests. Day 15 Get routine tests. Day 22 Get routine blood tests. Day 28 Get routine tests and exams. Get 2nd chest x-ray for research purposes. Day 29 Return to the investigator’s office at _______ [insert appointment time] for your next exam and to the next cycle. Future cycles Day What you do Days 1-28 Keep taking _____ once a day if you have no bad side effects and cancer is not getting worse. Call the investigator at _____________ [insert phone
Consent-and-Authorization-Knight-Cancer-Institute-FINAL-5-3-2013.docx