Information entered must be in compliance with OHRP (OIG Report notation) and FDA (Recruiting Study Subjects section) for clinical trial listings. The guidance limits information on web listings to: title, purpose of the study, basic eligibility criteria; study site/location and how to contact the study site for more information. Read the OHRP and FDA guidance before entering information.

Please answer all the questions below; all information is necessary for participation in the database. Incomplete submissions will NOT be posted. Only one study per form; please complete a new form for each additional study. Questions? Email clinicalstudies@uthscsa.edu.

PRINCIPAL INVESTIGATOR'S NAME: REQUIRED

CONTACT PERSON'S NAME: REQUIRED

Contact person's e-mail: REQUIRED

Contact person's phone: REQUIRED

Protocol Owner (enter University or University-related Department, Center, Institute or Program name of protocol owner):

Clinical trial/study website address: (if applicable)

Title of trial/study: REQUIRED
(This does not need to be the 'formal' or official title of the study.)

IRB # (format: HSC-XXXX-XXXX): REQUIRED

Funding source:

Type of research/study: (select all that apply):

Diagnostic	Intervention Study	Evaluation Study
Treatment	Controlled Clinical Trial	Sampling Study
Pilot	Multicenter Study	Twin Study
ProspectiveCohort Study	Other- describe briefly:

Phase of this trial/study:               Select one	Target group:                      REQUIRED: Select one	Target age: REQUIRED: Select at least one
Phase I	Male	All ages
Phase I / II	Female	Infant
Phase II	Either	Child
Phase II / III		Adult
Phase III		Elderly
Phase III / IV
Phase IV
N/A

Healthy volunteers sought: REQUIRED Yes     No

Conditions, diseases or illnesses being studied: REQUIRED

Purpose of Study: REQUIRED
Give only basic information concerning the purpose of the study by explaining what you are trying to learn by doing this study. Do not state your expectations or hopes that participants may benefit by their participation. Include only the basic requirements (e.g. age group, non-smoker, and diabetic). Do not include the investigator's qualifications. Do not include any form of compensation information such as monetary incentives, "free" exams, "free" medications/treatments, etc. Do not include any anticipated results. See OHRP and FDA links above. (Limit: 250 characters)

Start date of trial/study: REQUIRED  

Trial/Study is ongoing (no ending date)   Yes    No

If you answered NO, trial is not ongoing, you must provide end date of trial:  

Investigator's Department and Address: