Forms

Administrative Forms:

Protocol Application Form [DOC]
Outpatient Costs Worksheet [XLS]
Rare Disease Outpatient Costs Worksheet [XLS]
Progress Reports Form

Nursing Forms:

Request for Admission [RTF]
CRU Generic Flow Sheet Template [DOC]
Sample Flow Sheet Template [RTF]
General Medical Clearance Orders Template [RTF]
Out Patient Order Template [RTF]
In Patient Order Template [DOC]
Inpatient Drug Infusion Template [DOC]
Serial Specimen Sampling and Processing Flow Sheet Template [RTF]
Serial Specimen Sampling and Processing Orders Template [RTF]
Patient History Template [RTF]

Do's and Don'ts:

  • Remove the word “TEMPLATE” from example template when finalizing the orders
  • Signed consent and HIPAA forms are confirmed on the study participant’s first visit only.
  • Unless a protocol requires it, height does not need to be requested at every visit.
  • Flow sheets must coincide with MD orders.
  • Only a medical doctor is permitted to sign MD orders.
  • MD orders must be signed and dated for the date of the appointment, not the date it was signed
  • When ordering drugs, please indicate the following: name of drug, dose, route, & frequency.
  • Please stipulate how the drug will get to the unit. Who will order (CRU staff or study team? How will it get to the unit (picked up by study team or CRU staff)?
  • Ivy Cohen, Research Pharmacist MUST be contacted prior to scheduling study participants receiving investigational drugs.
  • Outpatients do not need an MD order to “admit” to CRU.
  • All inpatient visits require specific fields to be handwritten, ideally on day of admission: activity, allergies, and diet.
  • Encourage inpatients to bring medications taken at home in their original container, not pill boxes.
  • All MD orders pertaining to lab test requests must be specific. Do not simply state “Hematology”, “chemistry”, or “electrolytes”; rather, indicate the specific test or panel.
  • Refer to our MSH lab requisition form for the appropriate test as it pertains to your study.
  • Be sure to supply the names and contact numbers pertinent to your study

Contact Us

Find out if CRC can assist you with your research efforts:

Clinical Research Centers
Tel: 212-241-6045

Hours of Operation
Monday – Friday, 7am until 7pm