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MASS Advanced MRI Center APPENDIX F: Screening Form Department of Radiology MASS Medical School 55 Lake Avenue North Worcester, MA 01655 Tel: 5083340409 PIs name: IRB Docket #: Subject name (Print):
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Make sure to read all the instructions carefully before starting.
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Fill in your personal information such as name, age, gender, and contact details.
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Provide detailed information about your medical history, including past illnesses, surgeries, and any ongoing medical conditions.
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Answer all the questions truthfully and accurately, as this information will be used to determine your eligibility for the research study.
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Who needs subject screening form:

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Individuals who are interested in participating in a research study or clinical trial.
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People who fulfill the specific eligibility criteria set forth by the study or trial.
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Those who are willing to provide accurate and honest information about their medical history and current health status.
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A subject screening form is a document used to collect preliminary information about a potential research subject to determine whether they meet the eligibility criteria for participation in a study.
Researchers or study coordinators are usually responsible for completing the subject screening form.
The subject screening form is typically filled out by gathering information from the potential research subject through interviews, questionnaires, and medical records.
The purpose of the subject screening form is to assess whether a potential research subject meets the necessary criteria to participate in a study, ensuring the safety and accuracy of the research.
The subject screening form usually collects information such as medical history, demographics, current medications, previous treatments or surgeries, and other relevant data that may impact the subject's eligibility for the study.
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