Researcher Resources

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Forms & Templates

Budget & Billing

Budget & Billing Workbook SHC
(For studies with hospital services
involving adults only
)
LPCH
(For studies with hospital services
involving pediatrics only)

Budget & Billing process map SHC LPCH
Clinical Trials Charge Correction Flow Chart
SHC or LPCH
Billing Contacts SHC or LPCH
Medicare Billing Requires NCT# from ClinicalTrials.gov - FAQs SHC or LPCH

SHC & LPCH Contacts | CLIA/Lab Licenses

Contacts at the hospital SHC LPCH
Investigational Drug Services (IDS) Pharmacy Contacts SHC or LPCH
CLIA/Lab Licenses SHC or LPCH

Fees | Codes | Price Lists

Technical / Hospital Fees

These lists show retail pricing. Study discounts are applied via the Budget & Billing workbooks.

SHC LPCH
Professional Fees SHC LPCH

Radiology Exam Codes & Pricing List (SHC)
includes Hospital, Blake Wilbur, Sherman- Palo Alto, Redwood City 

(for LPCH, see LPCH Technical / Hospital Fees above)

SHC
Investigational Drug Services (IDS) Pharmacy Contacts and Fees SHC or LPCH
Research Discount Structure SHC or LPCH

Clinical Lab Codes & Pricing List 

FY18 version not yet posted, however, clinical labs in the Budget & Billing workbooks reflect FY18 pricing.  

SHC or LPCH

Templates: Protocols | IND | IDE

Regulatory Binder Table of Contents for IND studies Example
Regulatory Binder Table of Contents for IDE studies Example
Investigational New Drug (IND) Application Template
Investigational Device Exemption (IDE) Application Template
Protocol Templates and Guides:  NIH, Stanford, other
Website

Forms: Requests & Requisitions | Lab Forms | Patient Registration

CT/MRI Study Request Form
includes Hospital, Blake Wilbur, Sherman- Palo Alto, Redwood City
SHC or LPCH
Radiology Requisition Form SHC or LPCH
ECG, ECHO, & Pulmonary Lab Requisition Form SHC or LPCH
Nuclear Medicine — Study Request Form
For services in Nuclear Medicine (e.g., SPECT, PET/CT, Bone Density Scan)
SHC or LPCH
MRN Request Form (Medical Record Number) SHC or LPCH
Clinical Labs – Study Protocol Form
For study set-up of research labs, blood draws and/or processing
SHC or LPCH
Clinical Laboratory Documentation Request SHC or LPCH
Clinical Laboratory Regulatory Documentation memo SHC
Clinical Research Protocol Summary Form Sample
Schedule of Events Sample
Patient Registration Form – ENTIRE service charged to a Clinical Trial SHC
Patient Registration Form – PARTIAL service charged to a Clinical Trial SHC
Patient Registration Form – LPCH Registration/Admitting Letter LPCH
Patient Registration Form - Scheduling/Precertification Form
LPCH

CTRU: Guidelines | Templates | Directions for Participants

Research and EMR Systems: OnCore | Epic

Quicklinks

Spectrum Home Page

Research Management Group (RMG) Sponsored projects, grants, contracts, award management