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ATTACHMENT 2 - Sample Format
MEMBER INSTITUTION SUMMARY OF ACTIVITIES
(see text, sections VII.2.A.e. and VII.4.A.)
INSTITUTION:_______________________________________________________
PRINCIPAL
INVESTIGATOR:____________________________________________
COOPERATIVE AGREEMENT #______________ DATE____________________
- Case accession by calendar year of the current project
period (please prepare separate tables for therapeutic
and non-therapeutic studies)
| From the Member Institution |
Year 1 |
Year 2 |
Year 3 |
Etc. |
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| Phase II |
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| Phase III |
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| Pilot |
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| Subtotal |
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| % Eligible |
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| % Evaluable |
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- Number of follow-up cases at end of calendar year:
| From Primary and Affiliated
Institutions |
Year 1 |
Year 2 |
Year 3 |
Etc. |
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- Group administrative and scientific participation
during the current project period.
- Investigator Name
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- Committee
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- Activity
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- Protocol Chairmanships
- Open Protocol and #
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- Investigator Name
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- Protocols in Follow-up and #
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- Investigator Name
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- Institutional pilot studies and other research
contributions to the Group.
- Services to the Group (core lab, site visit, etc)
during the current project period.
- Number of quality assurance audits of the institution
during the current project period, and problems
identified, if any.
- Disciplinary actions imposed by the Group during the
current project period.
- Group-related publications (annual bibliography
limited to the current project period) authored by
institutional investigator(s).
- Ranking of institution's performance overall by Group
leadership (by quartile; see VII 2 A.b.)
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