Pulmonary Evaluation

*The timeline requirements for this form are as follows:
Assessment Time Frame: Screening occurs up to 45 days prior to the anticipated start of the conditioning regimen. May be performed earlier than 45 days prior to the start of the conditioning regimen.
Submission Time Frame: Within 5 business days of collection.

Date of Pulmonary Function Tests:
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning. Enter the date of most recent PFT test. Date can either be entered directly in the data field using the DD/MMM/YYYY format, or the calendar date picker can be used.

Per protocol pulmonary function testing is required at Screening. If this field is marked as “Intentionally Left Blank” a protocol deviation should be logged in the EDC.

If the date entered is a future date, a query will appear in the EDC.

Diffusing capacity of the lungs for carbon monoxide (DLCO) corrected for hemoglobin:
Report the subject’s documented DLCO in %. This field allows up to four characters.

FEV1 Predicted:
Report the subject’s documented FEV1 in %. This field allows up to four characters.

CCG v1.0 | CRF v1.3

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