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PROTOCOL REVIEW AND MONITORING COMMITTEE NURSING REVIEW SHEET PROTOCOL NUMBER/TITLE: Codes: 1=acceptable; 2=not acceptable; Area Score 3=acceptable with resolution of issues below Nurses Notes: (This area will not be transcribed in PRMC minutes, see below) Protocol Eligibility Study Parameters AE Reporting Drug Procurement Records to be Kept Patient Consent Form Present? Protocol Acceptable? Issues to be addressed by sponsor and/or PI: Major (written responses required): 1. Minor (written responses NOT required): 1. Print Name: Signature: Date: Please fax/scan this signed coversheet in addition to emailing to [email protected] 11100 Euclid Avenue Cleveland, Ohio 44106-5061 Phone 216-286-2294 Fax 216-201-4043 Case Comprehensive Cancer Center is a Comprehensive Cancer Center, as designated by the National Cancer Institute Template version: March 2016