Enrollment Packet

These are the items that are needed when enrolling a subject into P-ICECAP.

TIPS

💡 Call the hotline if you are unsure about eligibility

💡Subject MUST be on TTM BEFORE Randomization

💡 Consent Form — ensure you have the link to your site-specific e-consent or have a paper consent ready for when you enroll.❗Remember to always use the latest paper consent version, found in your regulatory documents in WebDCU.

Eligibility CRF

Enrollment CRF

💡 It is best practice to have WebDCU saved to your device in order to easily randomize.

💡Remember to upload completed pedsQL to your secure dropbox

English

2 days – <13 months

13 months – <2 years

2 – <5 years (updated 1/15/25)

5 – <8 years

8 – <13 years

13 – 18 years

Spanish

2 days – <13 months SPANISH

13 months – <2 years SPANISH

2 – <5 years SPANISH

5 – <8 years SPANISH

8 – <13 years SPANISH

13 – 18 years SPANISH

F514 POPC/PCPC — Captures child condition BEFORE cardiac arrest

F512 and F513 Modified Ped GCS — Captures child condition before randomization

F511 Family and Household Information — Enter into WebDCU

Participant Contact Information Form — Keep this at your site. This form will be uploaded to dropbox after
you have reached the family at 2 and 11 months.

Contact Tracking Log — Use this form to track each contact attempt.

CHOP Checklist with Critical Times