ࡱ> QSP_ Z bjbj .Fbbp8P$<PPPPdPlz8888.f$!H6"$ffu&;;;R8fHf;;;0;f|u;i4;<0l;($X($;($H;";7K^Fl($ : Inclusion/Exclusion Criteria (once the protocol is approved, this page must be copied, used as a checklist for screening subjects, signed by investigator, and inserted in research record for every subject screened): YesNoInclusion Criteria YesNoExclusion Criteria   In order to save labor, if the sponsor provides this information in a table or list in the protocol, the relevant pages of the sponsors protocol may be scanned and electronically pasted into this form. THE ORS SCANNER is available to investigators who do not have access to scanners within their departments or divisions. Email ORS at  HYPERLINK "mailto:ors@som.umaryland.edu" ors@som.umaryland.edu for assistance.  These columns for use when screening subjects. PAGE \# "'Page: '#' '"  Be specific, using quantitative criteria, if possible. For example, use hematocrit less than 30 (NOT just anemic). PAGE \# "'Page: '#' '"  Be specific (see comment above). For use during screening of subjects: ___________________________________________ ____________________ Name of Subject Date Screened Reviewed and subject acceptable for study: ___YES ___NO ___________________________________________ ____________________ Signature of Principal Investigator Date $ + 4 5 = > m n o p q    M N d f g h ! }wqqmh h 0J h 0Jj9h Ujh Ujh 0JUhf8jh CJUmHnHuh fHq h 5$jh 0J5<OJQJU\!jh 0J5<OJQJU h CJ%jh 0J5<KHOJQJUh *  4$Ifgd]$ 4$Ifa$gd]gd RIII $Ifgd]kd$$Ifl44F&4>"  t?0    4 laf4pyppp $Ifgd]kd$$Ifl4F&4>" t?0    4 laf4  yppp $Ifgd]kd$$Ifl4F&4>" t?0    4 laf4     yppp $Ifgd]kd"$$Ifl4F&4>" t?0    4 laf4    yppp $Ifgd]kd$$Ifl4F&4>" t?0    4 laf4 yppp $Ifgd]kdZ$$Ifl4F&4>" t?0    4 laf4     yppp $Ifgd]kd$$Ifl4F&4>" t?0    4 laf4     yppp $Ifgd]kd$$Ifl4F&4>" t?0    4 laf4     yppp $Ifgd]kd.$$Ifl4F&4>" t?0    4 laf4     yppp $Ifgd]kd$$Ifl4F&4>" t?0    4 laf4   ! yppp $Ifgd]kdf$$Ifl4F&4>" t?0    4 laf4! " # $ ( + ? yttaaR ^$Ifgd]$ 4$Ifa$gd]gd kd$$Ifl4F&4>" t?0    4 laf4? @ A B C TKKK $Ifgd]kd$$Ifl4F&.>"  t?0    4 laf4pC D E F G yppp $Ifgd]kd$$Ifl4F&.>" t?0    4 laf4G H I J K yppp $Ifgd]kd! $$Ifl4F&.>" t?0    4 laf4K L M N O yppp $Ifgd]kd $$Ifl4F&.>" t?0    4 laf4O P Q R S yppp $Ifgd]kdY $$Ifl4F&.>" t?0    4 laf4S T U V W yppp $Ifgd]kd $$Ifl4F&.>" t?0    4 laf4W X Y Z [ yppp $Ifgd]kd $$Ifl4F&.>" t?0    4 laf4[ \ ] ^ _ yppp $Ifgd]kd- $$Ifl4F&.>" t?0    4 laf4_ ` a b c yppp $Ifgd]kd $$Ifl4F&.>" t?0    4 laf4c d e f g yppp $Ifgd]kde $$Ifl4F&.>" t?0    4 laf4g h i j k yppp $Ifgd]kd$$Ifl4F&.>" t?0    4 laf4k l m o p  M ! G H yppkffffdppgd gd   !gd kd$$Ifl4F&.>" t?0    4 laf4 ! G X Y Z hf8h h 5jh 0J<OJQJUh  h 6CJH + W X Y Z gd   !gd  ,1h/ =!"#$% $$If!vh#v#v4#v>":V l44  t?05545>"4f4p$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v#v4#v>":V l4 t?05545>"4f4$$If!vh#v.#v#v>":V l4  t?05.55>"4f4p$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4$$If!vh#v.#v#v>":V l4 t?05.55>"4f4DyK ors@som.umaryland.eduyK :mailto:ors@som.umaryland.edu^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH <`<  NormalCJ_HmH sH tH X@X   Heading 1$<<@&5CJKH OJQJ^JaJ @@@   Heading 6$$@&a$5\DA`D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List 4@4 Header  !B'@B  Comment ReferenceCJaJ@@@   Comment Text CJOJQJ6U@!6  Hyperlink >*B*phH@2H ;0 Balloon TextCJOJQJ^JaJN/AN ;0Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 7Z7:ORS=ZORSAc=ORSrH=ORS-=ORS=BFBFBFBFrZ F! Z !      ! ? C G K O S W [ _ c g k H Z   "VrX!!8@,(    B?#" ? B S  ?mZyz%& 4N/O/D[G[>*urn:schemas-microsoft-com:office:smarttags PersonName N  Ac=rH=-==5r=rp Mg !X[p!X[33op Mg!VX[p Mg !X[a`s !0xY~ ;t"#I%]V'kb+\,38f8R: >0Br?B} E/ E3HIKAKL1SL]PPiUW6Z[5\n\]um`.c?Cc3do5pUTu]yz{{{%Zo| ]a*5*BY8[z?t"U"R0NfaVpr@Z`@UnknownG*Ax Times New Roman5Symbol3. *Cx ArialK,Bookman Old Style5. .[`)TahomaACambria Math"1hgg6:6:!24oo3qHX ? 2!xx Inclusion_Exclusion&lt;p&gt;Inclusion/Exclusion Criteria (once the protocol is approved, this page must be copied, used as a checklist for screening subjects, signed by investigator, and inserted in research record for every subject screened) : Yes No Inclusion Criteria Nicole GermrothSadzewicz, AnthonyOh+'0 |    Inclusion_ExclusionT<p>Inclusion/Exclusion Criteria (once the protocol is approved, this page must be copied, used as a checklist for screening subjects, signed by investigator, and inserted in research record for every subject screened) : Yes No Inclusion Criteria Yes No Exclusion Criteria </p>Nicole GermrothT<p>Inclusion/Exclusion Criteria (once the protocol is approved, this page must be copied, used as a checklist for screening subjects, signed by investigator, and inserted in research record for every subject screened) : Yes No Inclusion Criteria Yes No Exclusion Criteria </p>NormalSadzewicz, Anthony2Microsoft Office Word@@2cu;@2cu;6:՜.+,D՜.+,H hp   Microsofto Inclusion_Exclusion TitleEM     !emy _PID_HLINKS_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayNameEktContentLanguageEktEDescription EktContentType EktContentSubType EktCmsPath EktExpiryType EktDateCreatedEktDateModified EktCmsSizeEktSearchable EktQuickLinkekttaxonomyenabledEktFolderNameEktTaxCategoryEktDisabledTaxCategory_ReviewingToolsShownOnceAtnmailto:ors@som.umaryland.edue1?0HRPO website update - Industry toolkit items TSmolinski@som.umaryland.eduSmolinski, Tiffany Summary <p>Inclusion/Exclusion Criteria (once the protocol is approved, this page must be copied, used as a checklist for screening subjects, signed by investigator, and inserted in research record for every subject screened) : Yes No Inclusion Crie<p>Inclusion/Exclusion Criteria (once the protocol is approved, this page must be copied, used as a checklist for screening subjects, signed by investigator, and inserted in research record for every subject screened) : Yes No Inclusion Criteria @0dh@Ci<://www.hrpo.umaryland.edu/DownloadAsset.aspx?id=2147486998  !"#%&'()*+,./0123456789:;<=>?ABCDEFGIJKLMNORRoot Entry F|u;TData $1Table-($WordDocument.FSummaryInformation(@DocumentSummaryInformation8HCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q