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Coordinator Checklist

NIMICT Original

Coordinator Checklist

When you are about to approach a patient, please consider bringing the followings items:


Reading Glasses

-Often in hospital settings, admitted patients may not have their reading classes.

-Bring a variety of prescriptions (-1, -3, -5)


Hearing Device

To assist the hearing impaired, bring the following devices:


Listening system


PI Invitation

-PI invitation to the study with photo of team.

-A personal connection to the research team is the best practice to developing and maintaining trust.



-Info-graphics help explain clinical trial research terminology in a health literate manner.

-NIMICT provides infographics on:

Clinical trial basics

Neurological terminology



Remember to bring extra pens and informed consent documents!


*Remember the importance of culture and language of the patient


Consent Form- Research Team

Provide a Contact Form to patients and their family, friends, and caregivers



A neurologist is a doctor who specializes in brain and nervous system diseases. At most hospitals, neurologists care for people who have had strokes. Nurses, occupational therapists, physical therapists, and speech and language pathologists work with doctors to help care for persons with stroke. This program will last for 4 years, during this time the neurologist will monitor your treatment and recovery from your stroke.

- Your Doctor’s name is: ___________________________________________________

- Your clinic number is: ___________________________________________________


Nurse or Program Coordinator

Each hospital helping with this program has at least one person assigned to help organize the program for the medical center. This person is called the research nurse or program coordinator. This person helps schedule all the necessary tests and procedures and gathers the information to report to the main study center. The coordinator tends to be the main link between the patient, the neurologist, the scheduling system, other doctors and the main study center or hospital.

- Your Program Coordinator’s name is: ____________________________________

- S/he can be reached at: ________________________________________________



At different times during this program, information will be collected by someone other than the Program Coordinator. This person will not know anything about you except for your contact information and the fact that you are a part of the program. This person is called an interviewer. An interviewer is used to ensure that all of the collected information is correct.

- Your Program Coordinator’s name is: _________________________________

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