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RESEARCH PRO00015851 NU15B08 CHANG (VERSION 3: 01-11-2017)	

Types:      Research Oncology Treatment
Synonyms:  NU15B08, PRO00015851, 15851, PRO15851, CHANG

Screening	Repeat 1 time	Cycle length: 1 day	Day -28 to Day -1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs  (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Imaging
☑	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --		☑	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --		☐	MRI BRAIN W CONTRAST	Interval: --	Occurrences: --		☐	MRI BRAIN WO CONTRAST	Interval: --	Occurrences: --		☑	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --			Labs
☑	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --		☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Women only
		☑	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --	Comments:	Women only
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --					
Cycle 1	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs  (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Pharmacokinetic Instructions
☑	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Nursing Orders
☑	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Dispense Palbociclib
			Biologicals
  	PLACEHOLDER	Dose: --	Route: --		Dispense: --	Refills: --	Start: S						Day 15	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --					
Cycle 2	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
☑	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Dispense Palbociclib
			Biologicals
  	PLACEHOLDER	Dose: --	Route: --		Dispense: --	Refills: --	Start: S						Day 15	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --					
Cycle 3	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Imaging
☑	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --		☑	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --		☐	MRI BRAIN W CONTRAST	Interval: --	Occurrences: --		☐	MRI BRAIN WO CONTRAST	Interval: --	Occurrences: --		☑	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Pharmacokinetic Instructions
☑	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Nursing Orders
☑	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Dispense Palbociclib
			Biologicals
  	PLACEHOLDER	Dose: --	Route: --		Dispense: --	Refills: --	Start: S							
Cycle 4	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Imaging
☑	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
☑	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Dispense Palbociclib
			Biologicals
  	PLACEHOLDER	Dose: --	Route: --		Dispense: --	Refills: --	Start: S							
Cycle 5	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Imaging
☑	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --		☑	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --		☐	MRI BRAIN W CONTRAST	Interval: --	Occurrences: --		☐	MRI BRAIN WO CONTRAST	Interval: --	Occurrences: --		☑	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Pharmacokinetic Instructions
☑	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Nursing Orders
☑	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Dispense Palbociclib
			Biologicals
  	PLACEHOLDER	Dose: --	Route: --		Dispense: --	Refills: --	Start: S							
Cycle 6	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Imaging
☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
		☐	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
☑	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Dispense Palbociclib
			Biologicals
  	PLACEHOLDER	Dose: --	Route: --		Dispense: --	Refills: --	Start: S							
End of Treatment	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Nursing Orders
☑	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Vital signs (blood pressure, heart rate, respiratory rate, oral temperature, height, weight, and BSA)
		☑	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
		☑	ONC NURSING COMMUNICATION 11	Interval: --	Occurrences: --	Comments:	Complete physical exam
			Imaging
☐	CT CHEST W CONTRAST ABDOMEN W CONTRAST PELVIS W CONTRAST	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
		☑	MRI BRAIN W WO CONTRAST	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
		☐	MRI BRAIN W CONTRAST	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
		☐	MRI BRAIN WO CONTRAST	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
		☐	NM BONE SCAN WHOLE BODY	Interval: --	Occurrences: --	Comments:	If progression of disease occurs first, scan will be done as end of treatment
			Labs
☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --					
Follow-up Visits	Repeat 12 times	Cycle length: 1080 days	Follow-up	Perform every 1 day x1