SCHEDULE OF EVENTS / BILLING SCHEMA Protocol Name: Principal Investigator: Prepared By:
Estimated Number of Study Subjects:
Initial Visit Drug Studies Drug Bill patient or 3rd party Sponsor supplied Infusion/equip for Drug Pre Meds Infusion/equip for PreMeds Hydration Fluid Visit with Provider LABS CBC, DIFF, PLTS Creatinine BUN UA ANCILLARIES CT ABD CT Pelvis EKG SOC SOC X SOC SOC SOC SOC SOC
Procedure
Wk 1
Wk 2
Wk 3
Wk 4
FU @ 6mo FU @ 12mo
FU @ 24 mo
X X X X X X
X X X X X X
X X X X X X
X X X X X X SOC SOC SOC
X X X
X X X
X X X
X X X
SOC SOC SOC
SOC SOC SOC
X X
SOC SOC
SOC SOC
X = Billed to study sponsor or other internal sources. (Test or exam required solely for study purposes. Not standard care.) SOC = "Routine" Standard of Care; can bill insurance and/or patient. Consider both professional and technical components for billing.