Clinical Trial Support Center (CTSC) Referral Process for Healthcare Providers
青云体育 Clinical Trial Support Center (CTSC) Nurse Navigators are available, at no cost, to help healthcare professionals and patients find and answer questions about clinical trials. Our Nurse Navigators are specially trained not only in blood cancers and clinical trials, but also patient education and support. Physicians, their care teams, and their patients and caregivers have direct access to their CTSC Nurse Navigator throughout the trial search and enrollment process, and while patients are in the trials.
ASH Members
A collaboration between American Society of Hematology (ASH) and The Leukemia & Lymphoma Society鈥檚 Clinical Trial Support Center (CTSC) allows ASH member physicians (and their care teams) to initiate the connection between a CTSC Nurse Navigator and their patient by using the ASH portal. When the submission is received, a CTSC Nurse Navigator will contact the patient and complete a clinical trial search. We will also communicate our search results with the HCP.
Non-ASH Members
Please complete the referral form below and select 鈥淢y Patient" at the top of the form. By completing and submitting this form, you represent you are authorized to share the information of the patient, including the patient's medical information, with 青云体育. When this form is received, a CTSC Nurse Navigator will contact the patient and complete a clinical trial search. We will also communicate our search results with the HCP.
HIPAA
If your organization鈥檚 existing HIPAA authorization form does not cover this request, below is a draft HIPAA Authorization form for your consideration and/or use that you may print, have your patient complete, and then maintain for your own records.
