Description:

AMC-052 Screen Failure Form NCT00513526 Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A53B09A-E5AB-7491-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3A53B09A-E5AB-7491-E044-0003BA3F9857

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Versions (3) ▾
  1. 9/19/12
  2. 5/28/15
  3. 6/3/15
Uploaded on:

June 3, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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AMC-052 Screen Failure Form NCT00513526

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  1. StudyEvent: AMC-052 Screen Failure Form
    1. No Instruction available.
Patient infection medical history
HIV risk factor present
History of intravenous drug use
Anal cytology performed
Anal cytology result
High-resolution anoscopy performed
Anal biopsy performed
Most severe anal biopsy result
Anal HPV DNA PCR obtained
HPV Type 16 Results
HPV Type 18 Results
Screen Failure
Primary reason for screen failure

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