Scheduler

Create New Study

= Required Field

Overview

Institution *		Status *
Study Name *				Short Name
Industry Initiated *		CRC Category		CRC Approved Study?
Expected Start Date		Expected End Date		Adult/Pediatric
Total Outpatient Visits		Total Inpatient Visits		Total Subjects
Study Abstract	3000 characters remaining

Contacts

Principal Investigator *		Responsible Physician 1		Responsible Physician 2
Primary Scheduling Contact *		Secondary Scheduling Contact		Third Scheduling Contact
Protocol Nurse *		Associate Protocol Nurse
Protocol Nutritionist *		Associate Protocol Nutritionist

Identification

Local ID *		Catalyst ID		IRB Number
IRB Approval Date		Most Recent IRB Renewal Date		IRB Expiration
IRB Institution
NCT #		IND #		IDE #

Funding

* (Must select at least one funding source)

Funding Source 1
Centers and Institutes *
Grant ID		Site Cost Center
Total Direct Dollar Award	$	Total Indirect Dollar Award	$
Project Start Date		Project End Date
Comment

Funding Source 2
Centers and Institutes *
Grant ID		Site Cost Center
Total Direct Dollar Award	$	Total Indirect Dollar Award	$
Project Start Date		Project End Date
Comment

Funding Source 3
Centers and Institutes *
Grant ID		Site Cost Center
Total Direct Dollar Award	$	Total Indirect Dollar Award	$
Project Start Date		Project End Date
Comment

Funding Source 4
Centers and Institutes *
Grant ID		Site Cost Center
Total Direct Dollar Award	$	Total Indirect Dollar Award	$
Project Start Date		Project End Date
Comment

The use of this application is for business purposes only. Your use of this application is monitored and a record of access may be reviewed by the institution and may be made available to authorized persons, including the subject, upon request. By using this application, you agree to keep any information found within private. Unauthorized use or disclosure of subject PHI (Protected Health Information) is strictly prohibited.

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