ࡱ> /1.{ bjbjBrBr .  A80Lw>hh($gZ41??LvG0wLX|w :  Sample Patient Follow-up Letter [date] [patient name and address] Dear _________, It has been 6 months since you agreed to participate in the ____________ study. On the following page are the few follow-up questions we have in regards to how your health has been since your [treatment, drug, device] on [month/date/year]. Please complete and return the following page in the enclosed postage-paid envelope. We will be contacting you again in [number] months. Thank you for your participation in this important [registry, study]. If you have any questions regarding your participation, please do not hesitate to contact me at _____________or _________________________________at __________________. Thank you. [patient name] Since your [treatment, drug, device] on [month/date/year], have any of the following events happened? [Enter study-specific information, such as hospitalizations, surgeries, health conditions, adverse events/serious adverse events, or endpoints. The following is an example.] Heart attack YES NO Additional heart cath or stent YES NO Bypass surgery YES NO Any problems with the stent placed [date] YES NO Any surgery other than bypass YES NO If yes, list: ___________________________ [Enter any study-specific treatments, medications, or other following the example below.] If you answer NO to any of the following, please list the approximate stop date and reason. Are you still taking Plavix? YES NO If no: Stop date: ________________________ Reason: _____________________________________________________ Signed: Date:     This template is made available by CTN Best Practices and can be found at ctnbestpractices.org. CTNBP followupletter Page  PAGE 1 of  NUMPAGES 2  !#%)+,-DELV 3 5 6 E F     2 ; r t x         7 8 B D F K Q Z e p h]hbT h]h h]h]h]h9h >%hhohhRIhh?5CJOJQJaJh5CJOJQJaJh?D!"#*+FGWX C D 6 7 Q R $a$gd     & ' + , > ? u {     % , 8 9 : b c u +,6789>?@ABjh"6Uh]h]>*h h]hbTh]h? h]h h]h]Q 9 : ,-./ACDFGIJLM$a$gd !gd]BDEGHJKMRSկpp_[h? h]h]CJOJQJ^JaJ)h0JCJOJQJ^JaJmHnHu$hh]0JCJOJQJ^JaJ-jhh]0JCJOJQJU^JaJ hh]CJOJQJ^JaJh] hh]CJOJQJ^JaJh]CJOJQJ^JaJ h hrh]CJOJQJ^JaJjh"6Uh"6 !gd] gdF,1h/ =!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA`D Default Paragraph FontViV  Table Normal :V 44 la (k (No List l$@l Envelope Address!@ &+D/^@ CJ OJQJ^J4@4 Header  !4 @4 Footer  !.)@!. ] Page NumberPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  mm B   !@ @H 0(  0(  B S  ?"@AACDDFGIJLM$(,3*0ACDFGIJLM3333@AADDM@AACDEFGHIJKL? >%RI]obTFNLR:"69AC@@UnknownG*Ax Times New Roman5Symbol3. *Cx ArialE. Century GothicA$BCambria Math"1hu2 Gu2 Gf&S S !4>>2HX ?o2!xx  July 25, 2005amoorelori1Oh+'0P     $08@HJuly 25, 2005amoore Normal.dotmlori12Microsoft Office Word@@Dj@-?@-?S՜.+,0  hp  Genesis HealthCare System > July 25, 2005 Title  !"#$%'()*+,-0Root Entry Fp!??21TableWordDocument.SummaryInformation(DocumentSummaryInformation8&CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q