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0614 Forms
0614 Phase III Memantine/Placebo/WBRT

Forms In English
  1. Complete Forms Package
  2. A5 Demographic Data Form
  3. I1 Initial Evaluation Form
    (0614 I1 form is available for electronic data submission)
  4. F1 Follow-up Form
    (0614 F1 form is available for electronic data submission)
  5. TF Treatment Summary Form
    (0614 TF form is available for electronic data submission)
  6. T1 Radiotherapy Form
    (0614 T1 form is available for electronic data submission)
  7. Neurocognitive Training Procedure Letter
  8. MS Mini-Mental Status Examination
  9. NP Neurocognitive Evaluation Summary Form
    (0614 NP form is available for electronic data submission)
  10. PQ FACT-Br
    (0614 PQ form is available for electronic data submission)
  11. QL Medical Outcome Scale: Cognitive
    (0614 QL form is available for electronic data submission)
  12. Controlled Oral Word Association (COWA)
  13. Trail Making Part A and Part B
  14. Hopkins Verbal Learning test – revised (HVLT)
  15. Forms Package Index
  16. Guidelines for the Web [DOC]
  17. Investigational Agent Accountability Form [DOC]
  18. Guidelines to fill out a TF form [DOC]
Formulaires En Fran็ais
  1. MS Mini-Mental Status Examination [DOC]
  2. PQ FACT-Br
  3. Controlled Oral Word Association (COWA) - Form 1
  4. Controlled Oral Word Association (COWA) – Form 2
  5. Hopkins Verbal Learning test – revised (HVLT) - Form 1
  6. Hopkins Verbal Learning test – revised (HVLT) - Form 2
  7. Hopkins Verbal Learning test – revised (HVLT) - Form 3
  8. Hopkins Verbal Learning test – revised (HVLT) - Form 4
  9. Hopkins Verbal Learning test – revised (HVLT) - Form 5
  10. Hopkins Verbal Learning test – revised (HVLT) - Form 6
  11. Trail Making Test
  12. Trail Making Test Data Summary Form





  RTOG Meeting | June 24-27 2004 Capital Hilton, Washington D.C.