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Status:
Total Outpatient Visits
Total Inpatient Visits
Total Subjects
Expected Start Date
Expected End Date
Study Details
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
Actual First Visit Date
Last Scheduled Visit Date
Study Abstract
Contacts
Principal Investigator
Full Name
Credential
Division
Dept
Email Address
Phone #1
Phone #2
Pager
Responsible Physician 1
Full Name
Credential
Division
Dept
Email Address
Phone #1
Phone #2
Pager
Responsible Physician 2
Full Name
Credential
Division
Dept
Email Address
Phone #1
Phone #2
Pager
Primary Scheduling Contact
Full Name
Email Address
Institution
Contact Number
Secondary Scheduling Contact
Full Name
Email Address
Institution
Contact Number
Third Scheduling Contact
Full Name
Email Address
Institution
Contact Number
Protocol Nurse
Full Name
Email Address
Institution
Contact Number
Associate Protocol Nurse
Full Name
Email Address
Institution
Contact Number
Protocol Nutritionist
Full Name
Email Address
Institution
Contact Number
Associate Protocol Nutritionist
Full Name
Email Address
Institution
Contact Number
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
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