Review of HPB referrals |
X |
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Eligibility Form |
X |
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Surgeon’s Confirmation of Eligibility |
X |
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Enrollment Log |
X |
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Informed Consent Process |
X |
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Baseline Case Report Form |
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X |
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Quality of Life (EORTC-QLQ-C30 and EORTC-QLQ-LMC21) |
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X |
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X |
X |
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Surgery Worksheet (must be provided to surgeon prior to surgery) |
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X |
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Surgery Case Report Form |
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X |
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Pathology Case Report Form |
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X |
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Post-operative follow-up form (includes ECOG) |
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X |
X |
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Minor Complication Form (only if applicable) |
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X |
X |
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Major Complication Form (only if applicable) |
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X |
X |
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Health Resource Utilization Form |
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X |
X |
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Deidentify Data and send all study documents (enrollment log, case report forms and source) |
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X |
Survival Information (if applicable) |
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X |
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