CAPT Clinical Center Forms
- Initial Visit
- Patient Information [PDF, 46KB]
- Initial Visit Form [PDF, 123KB]
- Checklist for Eligibility [PDF, 52KB]
- Initial Laser Treatment Form [PDF, 61KB]
- Patient Log [PDF, 36KB]
- Initial Visit and FV60
- Quality of Life Form [PDF, 69KB]
- Multiple Visits
- Record of Subjective Refraction [PDF, 32KB]
- Follow-up
- Follow-up Visit Form [PDF, 97KB]
- Dietary Supplements Form [PDF, 44KB]
- Exit Interview [PDF, 48KB]
- FV12 Visit
- FV12 Treatment Form [PDF, 68KB]
- Safety Visit
- Safety Check Visit Form [PDF, 71KB]
- Telephone Visit
- Telephone Visit Form [PDF, 370KB]
- Outside Visit
- Outside Visit Form [PDF, 74KB]
- CC Transmittal Form
- Valid Transmittal Codes [PDF, 32KB]
- Coordinating Center Data Form Transmittal Log [PDF, 42KB]
- RC Transmittal Form
- Reading Center Photograph Transmittal Log [PDF, 18KB]
- Photograph Inventory Form [PDF, 44KB]
- Treatment Only Photograph Inventory Form [PDF, 44KB]
- Retake Photograph Inventory Form [PDF, 47KB]
- Exudative Event
- Miscellaneous
- Error Correction Form [PDF, 36KB]
- Missed Visit Form [PDF, 47KB]
- Patient Death Form [PDF, 41KB]
- Patient Search Form [PDF, 58KB]
- Transfer of Patient Form [PDF, 40KB]
- Pre-Randomization Review Submission of Photographs for Reading Center Review [PDF, 25KB]
- Administrative
- Feedback Form [PDF, 38KB]
- Staff Update Form [PDF, 35KB]
- Clinical Centers Update Form [PDF, 28KB]