Frederic C. Bartter
General Clinical Research Center (GCRC)
How to schedule patients
Prior to scheduling a patient on the GCRC, a VA form 10-10 must be filled out for all new patients. If you are unsure if a patient is new to the GCRC, fill one out anyway. Completed 10-10s can be faxed to the GCRC office at 567-4651. The following fields are required and must be filled in completely and legibly before a patient can be scheduled:
Applicant's name (Last, first, middle initial)
Sex
Address - street, city, state, county, zip code
Telephone number, including area code
Religion
Date of Birth
Place of Birth (city & state - or country)
Marital status
Person to be notified in case of emergency
Relationship to applicant
Address of emergency contact (if different from applicant's)
Telephone number of emergency contact
Social Security Number (full number)
A copy of the VA form 10-10 in PDF format can be downloaded from here.
(Download current version of Adobe Acrobat Reader - required to open pdf format of form.)
If you would prefer to fill out the form in Microsoft Word and email or fax it to our office, click here for the instructions and form. There is also the option to fill out the VA form 10-10 on the web.
Once the 10-10 has been sent, a reservation must be made with either Sharyn
Pryor (210-617-5248 or
pryor@uthscsa.edu ) or Terri Barnett (210-617-5248 or
barnettt@uthscsa.edu). To view the
days that the GCRC is
open, click on the link below.
When is the GCRC open? (HTML)
(Excel file)
Doctor's Orders
template (MS Word)
If you have any questions, feel free to contact the GCRC at 567-4632.
Date page last modified: 08/02/05 12:53 PM
