General Site Profile

Back to Medinexo

Medinexo
About-us
For Healthcare Providers
For Sponsors
Login / Register

Medinexo
About-us
For Healthcare Providers
For Sponsors
Login / Register

Medinexo
About-us
For Healthcare Providers
For Sponsors
Login / Register

Medinexo
About-us
For Healthcare Providers
For Sponsors
Login / Register

General Site Profile

Name *

Email Address *

have contributing in

Site Name *

Site Address *

Site’s Contact Name *

Site’s Contact Phone Number *

Identify which of the following activities apply to your institution (select all that apply): *

Clinical diagnostics (ex. Clinical laboratory, genetic or molecular testing, etc.)
Clinical interventions
General clinics (ex. Primary care, multidisciplinary clinics, etc.)
Specialty clinics (ex. Oncology group, etc.)
Imaging (ex. Radiology or imaging centers or departments, imaging software, etc.)
Infusions (ex. Oncology drug infusions, others)
Hospitalizations (Primary, secondary, tertiary hospital or network)
Surgeries (ex. Plastic surgery clinics, others)
Biosamples or biobank resources
Other

# of Currently Active Clinical Studies *

# of Past/Completed Clinical Studies *

Have you performed clinical trials in the last 5 years? * *

Are you interested in clinical trials? *

Yes
No
Not Sure

Are you interested in Decentralized Trials *

Yes
No

Does your clinic have an EMR (electronic medical records) *

Yes
No

Types of clinical trials completed *

Local only (in your country)
Global
Both
None

Experience in Bioequivalence Trials *

Yes
No
Other

Does your institution have a biobank facility? *

Yes
No

Does your institution partner with other biobanks or intermediaries to obtain biosamples? *

Yes
No

Is your institution interested in contributing to the biosample supply chain? *

Yes
No

Experiences in clinical trials *

Phase I
Phase II
Phase III
Phase IV
Post-marketing Phase
Other

What Sponsors have you worked with? *

What clinical research organizations (CROs) have you worked with? *

Typical patient enrollment rates per trial (%) *

Mark the Therapeutic Areas in which you have clinical experience *

Allergy
Cardiovascular
Dermatology
Emergency Medicine
Endocrinology
Family Medicine
Family Practice
Gastroenterology
Immunology
Infectious Disease Prophylaxis and Treatment
Internal Medicine
Nephrology
Neurology
Obstetrics and Gynecology (OB/GYN)
Oncology
Ophthalmology
Orthopaedics
Otolaryngology (ENT)
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Preventive Medicine
Psychiatry
Urology
Vaccine
Other

Type of organization *

Private Practice
Clinic
Hospital
Community Services
Stand-alone Research Facility
Academic
Other

Brief description of site's organization *

Number of Patients on File *

Number of active patients per month *

Ethnicity of patient population *

White
Afro-descendent
Asian
Native American
Latino
Other

Electronic Health Record System

Patient Age Groups *

Infant (1 month to 2 years)
Pediatric (3 to 12 years)
Adolescent (13 to 17 years)
Adult (18 to 64 years)
Geriatric (65 years +)

Patients' geography radius from site

Less than 10 miles (Less than 16 kilometers)
Up to 11 to 20 miles (17 to 32 kilometers)
Up to 21 to 50 miles (33 to 80 kilometers)
51+ miles (81+ kilometers)
Geriatric (65 years +)

Number of Investigators *

Areas of Interest

Number of Research Coordinators *

CRC Professional Credentials and Experiences *

Your Comments