Get Acrin Nlst 6654 Vital Status Update Interval Follow-up Coversheet - Acrin

The ACRIN NLST 6654 Vital Status Update Interval Follow-Up Coversheet is a crucial document used to update and report participant vital status. This guide provides clear and supportive instructions to help you fill out the form accurately and efficiently online.

Follow the steps to complete the coversheet online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the date of the vital status update or follow-up by filling in the appropriate date fields.
3. Select the participant's vital status. Choose from the options: Alive, Deceased, or Unknown. If you select Deceased, ensure to complete fields 2a through 2e before skipping to question 3.
4. If applicable, provide details regarding the date of death by entering the date in the specified field. Include the cause of death if known.
5. Indicate the source of information regarding the participant’s status. Choose from options such as family member, health care provider, or medical document.
6. Provide the place of death by filling in the address, city, state, zip code, and county. If unknown, select the appropriate option.
7. Indicate whether a copy of the death certificate has been requested, and note the date of the request if yes.
8. Select the follow-up reporting period from the list of options ranging from 6 months to 8 years.
9. Identify the source of follow-up contact by checking all that apply. Provide the date of the last direct contact if no contact was made.
10. Answer whether there has been any change to the participant contact information since the last contact. If yes, note to fax or mail an updated contact sheet.
11. Sign and date the form in the area designated for the person responsible for data and for the person entering data online.
12. Once all information is filled out accurately, save changes, and choose to download, print, or share the form as needed.

Complete your documents online today to ensure timely and accurate updates.