Case Report Forms

Visit 1 Visit 2 Visit 3
Anthropometry Form (ANT)
Baseline Medical History Form (BMH)
Baseline Respiratory Medication Use Questionnaire (RMU)
Blood Pressure Form (BPF)
CBC Form (CBC)
Chemistry Results Form (CRF)
COPD Exacerbations Form (CEF)
CT Scan Tracking Form (CTF)
Demographic Information Form (DEM)
Electronic Cigarette Form (ECF)
Enrollment Criteria Form (ECF)
Occult Blood Testing Form (OBT)
Personal Identifiers Form (PID)
PIE Screening and Consent Form (SAC)
Pregnancy Testing Form (PTF)
Respiratory Disease and Smoke Exposure Questionnaire (RDS)
ECG Evaluation Form (EEF)
Induced Sputum Worksheet (ISP)
Induced Sputum Worksheet (ISW)
Safety Assessment Form (SAF)
Sputum Processing Worksheet (SPW)











Biomaker Collection Form (BCF)
Bronch Specimen Processing (BPW)
Bronchitis Index Scoring (BIS)
COPD Exacerbations Form (CEF)
Electronic Cigarette Form (ECF)
Pregnancy Testing Form (PTF)
Study Medication Distribution Form (MDF)
Study Medication Tracking Form (MTF)
Supplemental Medication Form (SMF)







Visit 4 Visit 5 Visit 6
Post Bronchoscopy Phone Call Form (PCF)




BUN Creatinine Results Form (BCR)
Interval History and Physical (IHP)
Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
Supplemental Medication Form (SMF)
CT, Sputum and BAL Scheduling (CSB)
Interval History and Physical (IHP)
Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
Supplemental Medication Form (SMF)
Visit 7 Visit 8 Visit 9
CT, Sputum and BAL Scheduling (CSB)
Induced Sputum Worksheet (ISP)
Induced Sputum Worksheet (ISW)
Safety Assessment Form (SAF)
Sputum Processing Worksheet (SPW)

Biomaker Collection Form (BCF)
Bronch Specimen Processing (BPW)
Bronchitis Index Scoring (BIS)
BUN Creatinine Results From (BCR)
COPD Exacerbations Form (CEF)
Electronic Cigarette Form (ECF)
Pregnancy Testing Form (PTF)
Study Medicatin Distribution Form (MDF)
Supplemental Medication Form (SMF)

Post Bronchoscopy Phone Call Form (PCF)
Visit 10 Visit 11 Visit 12

Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
Supplemental Medication Form (SMF)

Occult Blood Testing Form (OBT)
Post Bronchoscopy Phone Call Form (PCF)
Study Medication Distribution Form (MDF)

Interval History and Physical (IHP)
Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
Visit 13 Visit 14 Visti 15
BUN Creatinine Results Form (BCR)
Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
Occult Blood Testing Form (OBT)
Spirometry Data Form (SDF)
Study Medication Distribution Form (MDF)
Occult Blood Testing Form (OBT)
St George's Respiratory Questionnaire (SRQ)
Study Medication Distribution Form (MDF)
Visit 16 Visit 17 Visit 18
COPD Assessment Test (CAT)
Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
CT, Sputum and BAL Scheduling (CSB)
Occult Blood Testing Form (OBT)
Study Medication Distribution Form (MDF)
Supplemental Medication Form (SMF)

Biomarker Collection (BCF)
COPD Assessment Test (CAT)
CT Scan Tracking Form (CTF)
Spirometry Data Form (SDF)
St. Geoge's Respiratory Questionnaire (SRQ)

Miscellaneous Forms    

Study Completion or Withdrawal  (SCW)
Adverse Events Form (AEF)
Protocol Deviation Form (PDF)
Shipping Inventory Form (SIF)

   

 

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