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APPENDIX B INTAKE FORMSSTUDY ELIGIBILITY Checklists form must be completed for all customers who are eligible for intensive services. Date: LIA Name: (PrePrinted) Center Name:Staff Name:Customer Name:
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How to fill out study eligibility checklist
How to fill out study eligibility checklist
01
Step 1: Obtain a copy of the study eligibility checklist.
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Step 2: Read through the checklist to familiarize yourself with the study eligibility criteria.
03
Step 3: Start at the beginning of the checklist and work your way through each requirement.
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Step 4: For each requirement, determine if you meet the eligibility criteria.
05
Step 5: If you meet a requirement, check it off on the checklist.
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Step 6: If you do not meet a requirement, leave it unchecked.
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Step 7: Continue this process until you have considered and checked off or left unchecked all the requirements on the checklist.
08
Step 8: Review the checklist once again to make sure you haven't missed anything.
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Step 9: Sign and date the checklist to indicate that you have completed it accurately.
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Step 10: Submit the completed study eligibility checklist as required.
Who needs study eligibility checklist?
01
Researchers conducting studies or clinical trials
02
Participants interested in applying for a study or clinical trial
03
Institutions or ethics committees reviewing study eligibility
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What is study eligibility checklist?
The study eligibility checklist is a document used to determine if a research study meets the criteria for enrollment.
Who is required to file study eligibility checklist?
Researchers or study coordinators are required to file the study eligibility checklist.
How to fill out study eligibility checklist?
The study eligibility checklist can be filled out by providing accurate information about the research study and its eligibility criteria.
What is the purpose of study eligibility checklist?
The purpose of the study eligibility checklist is to ensure that only eligible participants are enrolled in the research study.
What information must be reported on study eligibility checklist?
The study eligibility checklist must include information about the study's inclusion and exclusion criteria, as well as any necessary documentation.
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