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STANDARD OPERATING PROCEDURE Research Administration SOP No: A013 SOP Title: Service Order Worksheet (SOW)
Appendix 1: SOA/W Checklist
PI: RC: Department:
STU#_____________ Velos#___________
Quality Specialist: ____________________ Financial Analyst: ___________________________
UTSW Contact: ______________________ Peds or Non-Peds________________
Initial or MOD SOA: ________ If MOD SOA is there an executed SOA or PQF in place:__________
Date of previously executed SOA __________________
CTCA: Yes Not Required Date CTCA was fully executed_________ Protocol Version:______
Date Received from UTSW: ___________
Date Reviewed by RA Senior Director: ____________
Date Sent to RF Director for Pricing: ______________ Date sent “CMC PRICING COMPLETE” version: _______ Date sent “CMC READY TO ROUTE” version: _______
SOA executed date: ___________
Service Area Review and Approval/Acknowledgement Received Pathology/Lab Initial request______ Date finalized: ______
Contact: Dr. Matt Quintero, Director
LabResearchAdmin@Childrens.com
214-456-6146
Investigational Drug Services (IDS) Contact: Jordan Whitehill, PharmD IDRX Email: IDSRx@childrens.com 214-456-2924
Amanda Cortinas: 214-456-2612
Initial request______ Date finalized: ______
Radiology (MRI, CT, PET X-Ray) Contact: Brian Fox, Director Brian.Fox@Childrens.com 214-456-6104
Radiology (DEXA Bone Scan) Contact: Leisa Borders Leisa.borders@childrens.com 214-456-5128
Radiology –Cardiac Services (Cardiac ECHO, MRI) Contact: Dr. T. Hussain Mohammad.Hussain@UTSouthwestern.edu
Initial request______ Date finalized: ______
Initial request______ Date finalized:_____
Radiology –Cardiac Services (ECHO- MUGA) Initial request______ Date finalized:_____ Contact: Dr. Poonam Punjwani Thankavel
POONAM.PUNJWANI@childrens.com
Cardiac Services (ECG/EKG) Initial request______ Date finalized:_____ Contact: Dr. Ilana Zeltser
Ilana.zeltser@childrens.com
Ophthalmology Initial request______ Date finalized: ______ Contact: Bonnie Miller
Bonnie.Miller@UTSouthwestern.edu
214-648-382
