| 姓名(中文) | |
| 所屬機構 | |
| 所屬單位 | |
| PRS系統登錄設定 | |
| User Login Name | (即為登入帳號) |
| Full User Name | |
| Other User Information | (請填聯絡電話) |
| User Email | |
| Study Identification | |
| Organization's Unique Protocol ID | 如未自行設定計畫編號,請填TMU-JIRB案件編號 |
| Brief Title | 請填計畫簡短名稱(限制120字元) |
| Official Title | 請填計畫完整名稱 |
| Sponsor/Collaborators | |
| Sponsor | 如無廠商贊助,請填Taipei Medical University/Taipei Medical University Hospital/Wanfang Hospital/Shuang Ho Hospital |
| Oversight | |
| Approval Number | 請填TMU-JIRB案件編號 |
| Board Name | TMU-Joint Institutional Review Board |
| Board Affiliation | Taipei Medical University, Taiwan, R.O.C. |
| Board Contact Information Phone | +886-66202589 |
| Board Contact Information Ext. | 15313 |
| Board Contact Information E-mail | irb@tmu.edu.tw |
| Board Contact Information Address | 3F., Biomedical Technology Building, No. 301, Yuantong Rd., Zhonghe Dist., New Taipei City 235, Taiwan (R.O.C.) |
| Study Description | |
| Brief Summary | 1200個字元限制 |
| Detail Description | 2500個字元限制 |
| Study Design | |
| Primary Purpose | 請填主要用途 |
| Study Phase | 請填藥物發展階段 |
| Intervention Model | 請填平行設計/交叉設計/其他 |
| Masking | 請填盲性(開放/單盲/雙盲) |
| Allocation | 請填隨機分派 |
| Enrollment | 請填納入試驗人數 |
| Outcome Measures | |
| Primary Outcome Measure | 請填主要評估指標 ※請將每一項指標分開填寫,並註明評估時間點(time frame) |
| Secondary Outcome Measures | 請填次要評估指標 ※請將每一項指標分開填寫,並註明評估時間點(time frame) |
| Eligibility | |
| Minimum Age/ Maximum Age | 請填受試者最小及最大年齡 |
| Gender | 請填受試者性別 |
| Accepts Healthy Volunteers | 是否納入健康受試者 |
| Inclusion Criteria/Exclusion Criteria | 請填受試者納入/排除條件 |
| Contacts/Locations | |
| Central Contact Person | 請填聯絡人資料 |
| Overall Study Official | 請填計畫主持人資料 |
| Locations | Facility請依收案、執行地點填寫:Taipei Medical University、Taipei Medical University Hospital、Wanfang Hospital、Shuang Ho Hospital |