Primary Outcome Measures Secondary Outcome Measures 30. What will be measured and how? 31. Criteria for ending the study early. 32. Other important aspects of this project. Section G: Does your PROSPECTIVE Study involve any of the following? Select all that apply and complete relevant form(s). Category Questions Yes/No Complete Complete Form Form # # Protected Patient Does your research involve protected Yes 0001 Information patient information? No Informed Consent Does your study involve Informed Yes 0002 Consent? No Survey/questionnaire Does your study involve Yes 0003 survey/questionnaire? No Drugs/medication/food Does your study involve the use of Yes 0005 drugs/medication/food supplement No supplement/devices? Device/Equipment point Does your study involve the use of Yes 0006 of care devices device? No Patient Specimen & Does your project use specimen and Yes 0007 Genetic analysis Patient Specimen (Pathology & No Surgery) such as blood, urine..etc. or use genetic analysis of specimen/sample? Is your study a clinical trial, Clinical Trial Yes 0008 sponsored, funded study? No
Primary Outcome Measures Secondary Outcome Measures 30. What will be measured and how? 31. Criteria for ending the study early. 32. Other important aspects of this project. Section G: Does your PROSPECTIVE Study involve any of the following? Select all that apply and complete relevant form(s). Category Questions Yes/No Complete Form # Complete Form # Protected Patient Information Does your research involve protected patient information? Yes No 0001 Informed Consent Does your study involve Informed Consent? Yes No 0002 Survey/questionnaire Does your study involve survey/questionnaire? Yes No 0003 Drugs/medication/food supplement Does your study involve the use of drugs/medication/food supplement/devices? Yes No 0005 Device/Equipment point of care devices Does your study involve the use of device? Yes No 0006 Patient Specimen & Genetic analysis Does your project use specimen and Patient Specimen (Pathology & Surgery) such as blood, urine..etc. or use genetic analysis of specimen/sample? Yes No 0007 Clinical Trial Is your study a clinical trial, sponsored, funded study? Yes No 0008
FCHS%20Research%20Comm%20Appln%20template%20%2016%20JAN%202018.docx