Anticipated Recruitment Funnel and Projections: From the recruitment funnel analysis worksheet Total Expected Total Total Projected # Projected # of Projected # of Projected # of # of Patients Expected # Expected # of of Months to Patients to Patients to Patients to to Be of Patients Patients to Be Enroll Identify Consent (Enroll) Randomize Per Identified to Be Randomized Per Per Month Month Consented Month (Enrolled) 113 15 10 12 9 1.2 .8 Activities for Finding the Patients (“Filling the Funnel”) Patient Sources: Site Will Target the Following Sources of Patients (check all that apply): Investigator’s Database / Clinic Patients Patient Advocacy Groups ☐  Referrals from Primary Care Physicians / GPs ☐ Other:  ☐ Referrals from other Healthcare Professionals ☐ Other: Referrals from Patient Advocacy Groups ☐ Other:  Community Events / Health Fairs Other: ☐ ☐ Recruitment Tactics Site Will Focus on the Following Primary Tactics (check all that apply): Database / Chart Review (every 2 weeks) Traditional Advertising (Print, TV, Radio) ☐  Social Media Advertising (search engine Letters / Emails to Referring Colleagues ☐  optimization, website banner ads, facebook, etc.) Educational Session with Colleagues (e.g., lunch and Transportation advertising (e.g., billboard, ☐ ☐ learns, grand rounds) subway or bus) Advocacy group educational events / support Advocacy group newsletter postings / mailings   group activities ☐ Other: ☐ Other: ☐ Other: ☐ Other: Preliminary Materials, Resources and Budget Requests (Materials that will be (or are likely being) provided by the sponsor or Patient Recruitment Organization are noted in grayed out rows and only supplies are noted; for site-oriented activities the preliminary budget is included) Materials / Resources Needed Quantity Estimated PowerPoint Presentation study 1 $0.00 Pocket Inclusion / Exclusion cards 20 $0.00 Study Brochures (Patient Pamphlets) -English 200 $0.00 Study Brochures (Patient Pamphlets) 200 $0.00 –Spanish Part research assistant to conduct chart reviews 4 hours / week X 10 weeks @$50.00/hour $2000.00 –time
Anticipated Recruitment Funnel and Projections: From the recruitment funnel analysis worksheet Total Expected # of Patients to Be Identified Total Expected # of Patients to Be Consented (Enrolled) Total Expected # of Patients to Be Randomized Projected # of Months to Enroll Projected # of Patients to Identify Per Month Projected # of Patients to Consent (Enroll) Per Month Projected # of Patients to Randomize Per Month 113 15 10 12 9 1.2 .8 Activities for Finding the Patients (“Filling the Funnel”) Patient Sources: Site Will Target the Following Sources of Patients (check all that apply):  Investigator’s Database / Clinic Patients ☐ Patient Advocacy Groups  Referrals from Primary Care Physicians / GPs ☐ Other: ☐ Referrals from other Healthcare Professionals ☐ Other:  Referrals from Patient Advocacy Groups ☐ Other: ☐ Community Events / Health Fairs ☐ Other: Recruitment Tactics Site Will Focus on the Following Primary Tactics (check all that apply):  Database / Chart Review (every 2 weeks) ☐ Traditional Advertising (Print, TV, Radio)  Letters / Emails to Referring Colleagues ☐ Social Media Advertising (search engine optimization, website banner ads, facebook, etc.) ☐ Educational Session with Colleagues (e.g., lunch and learns, grand rounds) ☐ Transportation advertising (e.g., billboard, subway or bus)  Advocacy group newsletter postings / mailings  Advocacy group educational events / support group activities ☐ Other: ☐ Other: ☐ Other: ☐ Other: Preliminary Materials, Resources and Budget Requests (Materials that will be (or are likely being) provided by the sponsor or Patient Recruitment Organization are noted in grayed out rows and only supplies are noted; for site-oriented activities the preliminary budget is included) Materials / Resources Needed Quantity Estimated PowerPoint Presentation study 1 $0.00 Pocket Inclusion / Exclusion cards 20 $0.00 Study Brochures (Patient Pamphlets) -English 200 $0.00 Study Brochures (Patient Pamphlets) –Spanish 200 $0.00 Part –time research assistant to conduct chart reviews 4 hours / week X 10 weeks @$50.00/hour $2000.00