STARS

Welcome to the STARS screening page

Welcome to the STARS random number generator. You opened this page because you completed a screening form for a 10-24 year old patient with a non-firearm related injury (from an assault). Click on the button below to determine if the patient qualifies for our study.

All fields below are required.

YOUR INFORMATION
Academic Associate First Name:
Academic Associate Last Name:
Site:	please select... HUP CHOP
PROSPECTIVE PARTICIPANT INFORMATION
Birthdate:(mm/dd/yyyy)
Sex:	please select... Male Female
Race:	please select... Caucasian African American Hispanic Asian/Pacific Islander Native American Other

If you have any questions about this form, please contact Study Interviewer at 215-573-1877.

• Last updated: 11/12/2012