Request Status: To be Verified

Service Request

Principal Investigator / PI Delegate

(Only 1 Principal Investigator and Maximum 2 PI Delegate)

Select Your Role

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Add Principal Investigator / PI Delegate

Email or Portal User ID

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Select Role

Principal Investigator

PI Delegate

Email or Portal User ID

Member not found.

Member is not found.

Select Your Role

Principal Investigator

PI Delegate

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Project Information

IRB No.

Protocol Study Name

Protocol No.

Expected Study Start Date

Expected Study End Date

Final Report date

Primary Disease/Condition

Study Type

Interventional

Observational / Registry

Study Phase

Intervention Type

Medicinal Products

Allocation

Estimated total number of subjects

IRB Application Form

Protocol Document

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Medicinal Product / Clinical Procedure

All the medicinal product(s) are approved/allowed for marketing in Hong Kong

Yes

All the medicinal product(s) will be used according to their labelled instruction

Yes

Involving Clinical Procedures(s)/Assessment(s) not needed for subjects’ normal case

Yes, Invasive

Yes, Non invasive

Based on the study information provided above and HKU’s policy, the need for a Clinical Trial Insurance is: MANDATORY

Estimated No. of Subjects Recruited from HKW cluster

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Contract Service

Organization Information and Contact Person

Supporting Organization Name

First Name

LasT Name

Salutation

Title

Address

Telephone No.

Fax No.

Email Address

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Agreement / Contract

Contribution by the supporting Organization

Medicinal product(s)

Funding

Others

Ownership of study data and results

Investigator / HKU

Supporting Organization, reason

Ownership of intellectual property/knowhow

Investigator / HKU

Supporting Organization, reason

centre(s) to be coordinated by HKU

Single Centre

Multi Centres

Study Site

City, Country

Subject Recruitment Target (digit, >0)

Role

Study Site

Territory Coordinator

Principal Investigator

Name

Email Address

Primary Contract for Contract Negotiation

Name

Email Address

Yes

Study Site

City, Country

Subject Recruitment Target (digit, >0)

Role

Study Site

Yes

Territory Coordinator

Yes

Subject Recruitment Target (digit, >0)

Name

Email Address

Primary Contract for Contract Negotiation

Name

Email Address

Remove

Yes

Study Site

City, Country

Subject Recruitment Target (digit, >0)

Role

Study Site

Yes

Territory Coordinator

Yes

Subject Recruitment Target (digit, >0)

Name

Email Address

Primary Contract for Contract Negotiation

Name

Email Address

Remove

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Document Upload

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Electronic Data Capture (REDCap) Service

All new REDCap service has “Under Development” REDCap status while you are building and testing the database. While you are ready to enter real data, you are required to make another request later to change the REDCap status to “Live”.

I have have read and agreed with the Terms and Conditions for REDCap Service.

REDCap Information & Member

REDCap Short Name (as REDCap project title)

Primary Purpose

Others

Masking

ClinicalTrials.gov Identifier

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REDCap Member

(min. 0)

Email or Portal User ID

Email or User ID is not found.

Select STUDY ROLE

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Email Address*

Portal User ID*

Last Name

First Name

Type

Training Status

Study Role

poonwa@ha.org.hk

poonwa01

Poon

Type 2

Not completed

Builder & SC

chunkit@hku.hk

chunkit

Chan

Chun Kit

Type 1

Completed

Builder & SC

Email Address*

poonwa@ha.org.hk

Portal User ID*

poonwa01

Last Name

First Name

Poon

Type

Type 2

Training Status

Not completed

Study Role

Builder & SC

Remove

Email Address*

chunkit@hku.hk

Portal User ID*

chunkit

Last Name

Chan

First Name

Chun Kit

Type

Type 1

Training Status

Completed

Study Role

Builder & SC

Remove

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Other Services (Subject to evaluation and quotation by CTC)

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submit for verification

Withdraw

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Service Request

Principal Investigator / PI Delegate

Select Your Role

Add Principal Investigator / PI Delegate

Project Information

Medicinal Product / Clinical Procedure

Organization Information and Contact Person

Agreement / Contract

Document Upload

REDCap Information & Member

REDCap Member

Remarks