Microbicide Trials Network

MTN-030/IPM 041 Study Implementation Materials

Clinical/Safety/Product Use Management
Baseline Medical History Questions Form2016-Aug-1534.06 KB
CDC MEC for Contraceptive Use Summary Chart2016-Jul-31197.75 KB
Counseling Tools
Pre/Post Test and Risk Reduction Counseling Worksheet2016-May-1323.49 KB
Protocol Adherence Counseling Worksheet2016-Aug-0923.81 KB
Vaginal Ring Insertion Instructions2016-Aug-081.13 MB
Financial Disclosure
Financial Disclosure Form2016-May-0324.79 KB
Financial Disclosure Form Training Slides2016-Apr-29495.58 KB
Financial Disclosure Form, Protocol Version 2.02016-Dec-2025.09 KB
Informed Consent Support Materials
Informed Consent Comprehension Assessment2016-May-0323.53 KB
Informed Consent Comprehension Assessment True/False Template2016-May-0326.92 KB
Sample Informed Consent Coversheet2016-May-0323.76 KB
Other Tools/Templates
AVERY 5267 labels or equivalent2017-May-18229.5 KB
Body Mass Index (BMI) Calculator2017-Apr-2721.18 KB
Clinic Study Product Destruction Log2016-Aug-0936.66 KB
Eligibility Checklist2017-Jul-05901.4 KB
Enrollment Behavioral Eligibility Worksheet2017-Jan-11418.55 KB
Follow Up Visit Scheduling and Last Day to Enroll Tool2017-Mar-0721.46 KB
LDMS Tracking Sheet2017-Mar-1574.16 KB
MTN PSP Emergency Phone Contact Form2017-Jan-0623.46 KB
Protocol Safety Review Team Query Form2017-Jan-0627.07 KB
Safety Lab Results Calculator2017-Apr-1426.52 KB
Screening and Enrollment Log2016-May-0328.4 KB
Screening Behavioral Eligibility Worksheet2017-Jan-11407.56 KB
Site-Specific Clinic Study Product Accountability Log2016-Aug-0944.62 KB
Small Slide Specimen Labels2017-May-18293.5 KB
SMS Technical Manual2017-Apr-271.06 MB
Visit Checklists
01: Screening Visit Checklist2017-Mar-0147.4 KB
02: Enrollment Visit Checklist2017-Mar-01119.5 KB
03: Day 1, Day 2, and Day 3 Visit Checklist2017-Mar-01116 KB
04: Day 7 Visit Checklist2017-Mar-0142.66 KB
05: Day 14/PUEV/Early Termination Visit Checklist2017-Mar-01128 KB
06: Day 15 Visit Checklist2017-Mar-01114.5 KB
07: Day 16 Visit Checklist2017-Mar-01117 KB
08: Pelvic Exam Checklist2017-Mar-01102 KB