Get E1z11 Comorbidity Checklist Form 3452 Becogb Protocol - Ecog

The E1Z11 Comorbidity Checklist Form 3452 BECOGb Protocol - Ecog is an essential tool for assessing various health conditions. This guide provides clear and supportive instructions on how to complete the form accurately online.

Follow the steps to fill out the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling in the ECOG protocol number and ECOG patient ID as indicated at the top of the form.
3. Enter the patient initials in the specified format (Last, First) for identification purposes.
4. Record the date of assessment in the format of MM/DD/YYYY.
5. Indicate the report period, selecting 'Baseline' from the provided options.
6. In the first section, assess any past diagnoses by checking the appropriate boxes for each listed condition. If applicable, follow up by marking whether the individual's activities are limited by this condition.
7. Complete the smoking history section by marking an 'X' next to the appropriate response for the smoking questions. Provide answers regarding current smoking status, daily consumption, and the duration since the last cigarette.
8. Review all entered information for accuracy before finalizing.
9. Save your changes and then choose to download or print the completed form for your records. You may also share it as required.

Complete the E1Z11 Comorbidity Checklist Form 3452 BECOGb Protocol - Ecog online today.