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- Complete Forms
- Forms Package Index
- Demographic Data Form Instructions
A5 Demographic Data Form
- I1 Initial Evaluation Form
(0534 I1 form is available for electronic data submission)
- F0 Interim Follow-up Form
(0534 F0 form is available for electronic data submission)
- F1 Followup Form
(0534 F1 form is available for electronic data submission)
- PQ American Urological Association Symptom Index (AUA SI)
(0534 PQ form is available for electronic data submission)
- FA EPIC
(0534 FA form is available for electronic data submission)
- HP HSCL-25
(0534 HP form is available for electronic data submission)
- QF EQ-5D
- SA Utilization of Sexual Meds/Devices
(0534 SA form is available for electronic data submission)
- T1 Radiotherapy Form
(0534 T1 form is available for electronic data submission)
- Dosimetry Transmittal Form
- CS Neurocognitive Evaluation Summary Form** (0534 CS form is available for electronic data submission)
(Reports the results of the HVLT-R, the Trail Making Test and the COWA)
**The actual neurocognitive test forms are to be retained at the institution while the results only are reported on this summary form.
Quality of Life Neurocognitive Assessments
- Neurocognitive Training Procedure Letter
- Hopkins Verbal Learning Test (HVLT-R 1-6)
- Controlled Oral Word Association (COWA)
- Trial Making Tests Part A Part B
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