ONJ Study
For more information on Factor 5 Leiden for our patients and their families from Hamilton Heath Services, click here.
Attachments Needed for all Entry Patients:
2, 00, 4, 5 Additional Attachments needed for “Yes” Patients: 000, 0, 1, 3, 7 Attachment needed for “Questionable” Patients: 3, Recall Appointment in 4-6 weeks Attachments needed for “No” Patients: None |
List of Attachments for ONJ Study: 000. Patient’s Instruction Sheet for ONJ Study
00 a. Doctor’s Instructions for “In-Person” Interview b. Doctor’s Instructions for Phone Interview c. Doctor’s Checklist of Completed Attachments 0. Patient Contact Information 1. Diagram for ONJ Study 2. Consent Document for ONJ Screening/Interview 3. HIPAA 4. Medical Risk Factor Assessment Interview (4a) Section a. Osteoporosis Section b. Steroid Section c. Cancer 5a. Dental Questionnaire Interview 5b. Timeline of Jaw Pain 6. Patient # (Letter/Number/-Letter Identification Code) 7. Informed Consent for Blood Draw 8. Laboratory Results Form/Interview 9. Log of Laboratory Results 10. Doctor’s Order/Laboratory Instruction Sheet |