Ped-PRO-CTCAE/Ped-PRO-CTCAE [Caregiver] Instrument & Form Builder

Pediatric PRO-CTCAE^®/Pediatric PRO-CTCAE^® [Caregiver]

Use of Ped-PRO-CTCAE^® and Pediatric PRO-CTCAE^® [Caregiver] are subject to NCI's Terms of Use. Preview the symptom terms included in the Ped-PRO-CTCAE Item Library using the quick guide. You may download the full instrument for reporting by children and adolescents ages 7-17 (Ped-PRO-CTCAE) or the full instrument for reporting by a caregiver for children ages 7-17 who are unable to self-report (Ped-PRO-CTCAE [Caregiver]). You may also use our Form Builder to produce a customized Ped-PRO-CTCAE or Ped-PRO-CTCAE [Caregiver] survey for your study. Form Builder is quick, easy to use, and eliminates the potential for cutting and pasting errors.

• English
  • English [Child/Adolescent 7–17 years] (PDF, 1.4 MB)
  • English [Caregiver] (PDF, 1.4 MB)
• Chinese (Simplified)
  • Simplified Chinese [Child/Adolescent 7–17 years] (PDF, 544 KB)
  • Simplified Chinese [Caregiver] (PDF, 557 KB)
• Italian
  • Italian [Child/Adolescent 7–17 years] (PDF, 381 KB)
  • Italian [Caregiver] (PDF, 387 KB)

Section 508 compliance: The English version of the full instrument is accessible to assistive technologies, but translated versions may not be. If you have difficulty reading the instrument, contact us or use HHS Language Assistance Services.