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AMC-070 Overall Assessment Form (RK6)

- 09/10/17 - 1 modulo, 4 itemgroups, 13 elementi, 1 linguaggio
Itemgroups: Header - Overall Assessment Form, Overall Assessment, Disease Response, Comments
AMC-070 Overall Assessment Form (RK6) Lenalidomide in Treating Patients With AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91E4BBD6-693F-9CA4-E040-BB89AD437D79

AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ)

- 09/10/17 - 1 modulo, 3 itemgroups, 13 elementi, 1 linguaggio
Itemgroups: Neurotoxicity Questionnaire Form, Neurotoxicity Questionnaire Form, Comments
AMC-063 FACT/GOG-Neurotoxicity Questionnaire Form (NTQ) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=816407E2-1423-1A8A-E040-BB89AD433DA9

AMC-063 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F37)

- 09/10/17 - 1 modulo, 4 itemgroups, 14 elementi, 1 linguaggio
Itemgroups: Header - AIDS and Cancer Specimen Resource (ACSR) Procurement Form, Specimen Procurement, Contact Information, Comments
AMC-063 AIDS and Cancer Specimen Resource (ACSR) Procurement Form (F63) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=815F9798-9F3D-E20D-E040-BB89AD435094

AMC-070 Evaluation of KS Lesions Form (RK3)

- 09/10/17 - 1 modulo, 8 itemgroups, 42 elementi, 1 linguaggio
Itemgroups: Header - Evaluation of KS Lesions Form, Evaluation of Foot KS, Evaluation of Oral Cavity, GI Evaluation, Pulmonary Evaluation, Measurements, Bronchoscopy, Comments
AMC-070 Evaluation of KS Lesions Form (RK3) Lenalidomide in Treating Patients With AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=91E37C30-3D1D-3E5F-E040-BB89AD43368B

AMC-063 Missed Visit Form (F35)

- 09/10/17 - 1 modulo, 3 itemgroups, 6 elementi, 1 linguaggio
Itemgroups: Header - Missed Visit Form (F35), Missed Visit Information, Comments
AMC-063 Missed Visit Form (F35) Bortezomib in Treating Patients With Relapsed or Refractory AIDS-Related Kaposi Sarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=815FD129-E16B-59A5-E040-BB89AD431E71

KBV Remedy Prescription Template 13

- 29/09/17 - 1 modulo, 9 itemgroups, 54 elementi, 1 linguaggio
Itemgroups: Header, Remedy Prescription, Prescription, Prescription, Diagnosis, Approval, Footer, Receipt, Treatment
Muster 13 - Heilmittelverordnung Maßnahmen der Physikalischen Therapie/ Podologischen Therapie (Freigabe 24.09.2014). Freigabe durch Dezernat 4 - Ärztliche Leistungen und Versorgungsstruktur Geschäftsbereich Sicherstellung und Versorgungsstruktur Abteilung Sicherstellung Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Quelle: http://www.kbv.de/html/formulare.php --- Template 13 - Remedy Prescription (Released 09-29-2014). Released by Department 4 - Medical treatment and structure of supply, division ensurance and structure of supply, department ensurance Herbert-Lewin-Platz 2 10623 Berlin Tel: + 49 (0) 30 - 4005 -1418 Fax: + 49 (0) 30 - 4005 - 271418 Email: SJohn@KBV.de Web: www.kbv.de Source: http://www.kbv.de/html/formulare.php

Clinical Data Review Form GSK Ropinirole Restless Legs Syndrome 101468

- 18/09/17 - 1 modulo, 2 itemgroups, 25 elementi, 1 linguaggio
Itemgroups: Instructions, Review Comments
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome Clinical Data Review Form

AE Section GSK Ropinirole Restless Legs Syndrome 101468

- 18/09/17 - 1 modulo, 2 itemgroups, 17 elementi, 1 linguaggio
Itemgroups: Patient Information, Adverse Event
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome AE Section

Follow-Up GSK Ropinirole Restless Legs Syndrome 101468

- 13/09/17 - 1 modulo, 11 itemgroups, 77 elementi, 1 linguaggio
Itemgroups: Patient Information, Pregnancy Test, Vital Signs, 12 Lead ECG, Clinical Chemistry & Hematology, Drug Screening (Urine), Urinanalysis, Pregnancy, Study Conclusion, Adverse Event, Investigator's Statement
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome Follow-Up

Concomitant Medication Section GSK Ropinirole Restless Legs Syndrome 101468

- 12/09/17 - 1 modulo, 2 itemgroups, 14 elementi, 1 linguaggio
Itemgroups: Patient Information, Concomitant Medication
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome Concomitant Medication Section (Treatment Phase and Follow-Up)

Extra Clinic Visit 2 GSK Ropinirole Restless Legs Syndrome 101468

- 11/09/17 - 1 modulo, 7 itemgroups, 41 elementi, 1 linguaggio
Itemgroups: Patient Information, Predose Checklist, Pre-Dose Vital Signs, Dosing Details, Post-Dose Vital Signs, Adverse Event, Study Protocol
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome Extra Clinic Visit 2

Extra Clinic Visit 1 GSK Ropinirole Restless Legs Syndrome 101468 - Dose Level 7 GSK Ropinirole Restless Legs Syndrome 101468

- 11/09/17 - 1 modulo, 7 itemgroups, 41 elementi, 1 linguaggio
Itemgroups: Patient Information, Predose Checklist, Pre-Dose Vital Signs, Dosing Details, Post-Dose Vital Signs, Adverse Event, Study Protocol
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome Extra Clinic Visit 1

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