SCHEDULE OF EVENTS / BILLING SCHEMA Protocol Name: Principal Investigator: Prepared By: Estimated Number of Study Subjects: FU @ 24 Initial Visit Procedure Wk 1 Wk 2 Wk 3 Wk 4 FU @ 6mo FU @ 12mo mo Drug Studies Drug Bill patient or 3rd party Sponsor supplied X X X X Infusion/equip for Drug X X X X Pre Meds X X X X Infusion/equip for Pre- X X X X Meds Hydration Fluid X X X X Visit with Provider SOC X X X X SOC SOC SOC LABS CBC, DIFF, PLTS SOC X X X X SOC SOC Creatinine SOC X X X X SOC SOC BUN SOC X X X X SOC SOC UA SOC ANCILLARIES CT ABD SOC X SOC SOC CT Pelvis SOC X SOC SOC EKG X 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.
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