7
Neuroradiological Report
11
Special Testing Circumstances--See COORDINATOR (if checked)
15
Aphasia Description (if any)
21
Clinical Information Notes
26
Date of Testing (grant info)
67
Grant No. (grant info)
70
Hospital Record Obtained
71
If Y, Hospital Record Obtained
72
Last Date Coordinator Checked for Appt
73
Last Date When Checked for Neuroradiology Reports
90
Location of Visual Defect
96
Patient Outside of HUP
97
Patient Says "OKAY" to Participate
98
Protocol No. (grant info)
99
Protocol Title (grant info)
103
Scheduled Appointment
105
Scheduling Notes y or n