Clinical Trial Status Report Form (Singapore) Mobile App

Included Fields

Customize to add, remove, or edit any of the fields below.

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  HSA Clinical Trial PRISM Application No:

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  Local Sponsor:

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  Protocol No:

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  Protocol Date:

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  Title of Clinical Trial:

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  Centre

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  Name of Principal Investigator

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  Designation

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  Name of Clinical Trial Centre

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  Planned No.

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  3.1 Status of Clinical Trial* * Status of Clinical Trial: Not started yet, Ongoing, Suspended, Te...

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  3.2 If clinical trial has started, please provide the date of initiation (DD/MM/YYYY)

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  3.3 If clinical trial has not started, please provide reason

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  3.4 If clinical trial has completed, please provide the date of completion (DD/MM/YYYY)

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  3.5 If clinical trial is suspended, please provide the date of completion (DD/MM/YYYY) Please pro...

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  3.6 If clinical trial has been terminated / prematurely closed, please provide date of terminatio...

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  3.7 If site has been prematurely closed, please provide date of site closure (DD/MM/YYYY) Please ...

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  3.8 No of subjects screened

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  3.9 No of screened failures

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  3.10 No of subjects pending screening outcome

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  No of subjects enrolled (i.

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  3.12 No of subjects withdrawn or prematurely terminated

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  3.13 Please provide reasons for subjects withdrawal or premature termiantion

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  3.14 No of subjects ongoing

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  3.15 No of subjects completed

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  3.16 No of SAEs experiences by local subjects

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  Has there been an internal audit conducted for this clinical trial site?

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  3.18 Please provide any supplementary information to this status report, if necessary:

• ...and More!