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1、RESEARCHPROTOCOLTEMPLATEPHASEIISINGLEAGENTShortFormCaseComprehensiveCancerCenter11100EuclidAvenue,Wearn152Cleveland,Ohio44106-5065January201244CASE____SHORTFORMPHII,SINGLEAGENTProtocolVersionDated__/__/__TEMPLATEINSTRUCTIONSThe“ShortFormTemplate”isatoolforinvestigatorstoensurethatallsectio
2、nsoftheProtocolareincludedinthedocument.Italsocontainsthe“boilerplate”languageforsectionsthatarerequiredinallprotocols.ThetemplateisnotintendedtosupersedetheroleofthePrincipalInvestigatorintheauthoringandscientificdevelopmentoftheprotocol.1.PromptsareshownasFORMFIELDS.2.Deleteanyitalicized
3、instructionsandexamplesasyoucompletetheinformationrequested.Investigatorsmayalsorefertothe“LongFormTemplate”whichprovidesboilerplatelanguageaswellasdetailedinstructions,promptsforinformation,andexamples.44CASE____SHORTFORMPHII,SINGLEAGENTProtocolVersionDated__/__/__CASECOMPREHENSIVECANCERC
4、ENTER__________________________________________________________________STUDYNUMBER:_____________STUDYTITLE:_____________ExampleofUHLeadPRINCIPALINVESTIGATOR:NameofPhysician,MDCaseComprehensiveCancerCenterUniversityHospitalsCaseMedicalCenterSeidmanCancerCenter11100EuclidAvenueCleveland,OH44
5、106TelephoneincludingareacodeEmailaddressCO-PI:NameofPhysician,MDCaseComprehensiveCancerCenterClevelandClinicTaussigCancerCenter9500EuclidAvenueCleveland,OH44195TelephoneincludingareacodeEmailaddressCO-INVESTIGATOR:NameofPhysician,MDCaseComprehensiveCancerCenterNameofInstitutionNameofCance
6、rCenterStreetAddressCity,State,ZipTelephoneincludingareacodeEmailaddressListadditionalco-investigatorsSTATISTICIAN:NameofStatistician,DegreeCaseComprehensiveCancerCenterNameofInstitutionNameofCancerCenterStreetAddressCity,State,ZipTelephoneincludingareacodeEmailaddress44CASE____SHORTFORMPH
7、II,SINGLEAGENTProtocolVersionDated__/__/__SPONSOR:CaseComprehensiveCancerCenterSUPPORT:SUPPLIEDAGENT(S):IND#:ifapplicableOTHERAGENT(S):44CASE____SHORTFORMPHII,SINGLEAGENTProtocolVersionDated__/__/__SCHEMA44CASE____SHORTFORMPHII,SINGLEAGENTProtocolVersionDated_
