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Ancillary Study Application Schematic
Pediatric Qualtiy of Life Inventory
Ancillary Study Policy
P-ICECAP Ancillary Study Policy (Google Doc)
*PDF available upon request
SIREN Ancillary/Substudy Approval process
Ancillary Study Application Schematic
Consent Practice Tools
P-ICECAP E-consent Practice Enviornment
P-ICECAP E-consent Practice Enviornment with Bill of Rights and HIPAA sections
Forms & Logs
Participant Contact Information Form
Family and Household Information Form
IDE
FDA IDE Approval with Contingencies - May 2021 (Updated 11/3/22)
FDA IDE Approval with Contingencies - August 2021 (Updated 11/3/22)
FDA IDE Approval with Contingencies - March 2022 (Updated 11/3/22)
FDA IDE Approval with Contingencies - June 2022 (Updated 8/11/22)
FDA IDE Approval with Contingencies - July 2022 (Updated 8/11/22)
FDA IDE Approval with Contingencies - October 2022 (Updated 10/27/22)
IRB
Protocol Approval with Modifications - Version 2 (Updated 8/11/22)
Pediatric Quality of Life Inventory
English
Spanish (Updated 6/2/22)
Resources
C.S. Mott P-ICECAP Ordersets -PDFs
CHOP Pediatric Cardiac Arrest Clinical Pathway
Eligibility Checklist with Critical Times
Follow-up Family Reminder Card
P-ICECAP Incl-Excl Screening Checklist
3 and 12 month Post CA Window Calculator