Process for the online submission of CTN forms where the study sponsor is King Edward Memorial Hospital for Women The details from this from will be copied and pasted into the online CTN application. Please enter the following details and send the completed from as a Word document to the WNHS Research Governance Office. This form will be checked and forwarded to Prof Jeff Keelan who will complete the online CTN submission on your behalf. Email completed form to: KEMH Details HREC Name Women and Newborn Health Service HREC EC00350 HREC number 2015 EW Notification Fee $335 Trial Details text Contact Name: Contact Phone number Number Contact Email Protocol Number Expected Trial Start dd/mm/yyyy Date Expected Completion dd/mm/yyyy Date Potential Use of YES or NO Restricted Goods Title of Study text Phase 1 Phase 2 Phase 3 Phase 4 Select one Trial Type Bioequivalence/Bioavailability (delete others) Device Trial Type Description Optional text, if trial (if necessary) type not listed above Total Number of Patients to be Enrolled Enter number in Trial Cardiovascular system Central Nervous System Ear/Nose/Throat Eye Gastrointestinal System Genitourinary System Select one Therapeutic Area Immune System/Inflammation Infections (delete others) Multiple Indications Musculoskeletal systems Neoplastic disorder Respiratory System Skin Other
Process for the online submission of CTN forms where the study sponsor is King Edward Memorial Hospital for Women The details from this from will be copied and pasted into the online CTN application. Please enter the following details and send the completed from as a Word document to the WNHS Research Governance Office. This form will be checked and forwarded to Prof Jeff Keelan who will complete the online CTN submission on your behalf. Email completed form to: KEMH Details HREC Name Women and Newborn Health Service HREC EC00350 HREC number 2015 EW Notification Fee $335 Trial Details Contact Name: text Contact Phone Number number Contact Email Protocol Number Expected Trial Start Date dd/mm/yyyy Expected Completion Date dd/mm/yyyy Potential Use of Restricted Goods YES or NO Title of Study text Trial Type Phase 1 Phase 2 Phase 3 Phase 4 Bioequivalence/Bioavailability Device Select one (delete others) Trial Type Description (if necessary) Optional text, if trial type not listed above Total Number of Patients to be Enrolled in Trial Enter number Therapeutic Area Cardiovascular system Central Nervous System Ear/Nose/Throat Eye Gastrointestinal System Genitourinary System Immune System/Inflammation Infections Multiple Indications Musculoskeletal systems Neoplastic disorder Respiratory System Skin Other Select one (delete others)