SCHEDULE OF EVENTS BILLING SCHEMA Protocol Name Principal Investigator Prepared By Estimated Number of Study Subjects

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SCHEDULE OF EVENTS BILLING SCHEMA Protocol Name Principal Investigator Prepared By Estimated Number of Study Subjects Powered By Docstoc
					                                                      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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