Request for CCS/CARS Services
To request services at this time, please check all items of interest and complete the information below. Please
send to Cheryl LaRue @ Box 1054 or fax signed document to 935-5862.
Regulatory and Budget Services:
IRB submission, follow up &
other committees as required
Study budget preparation/negotiation
Assistance with pre-study
site initiation activities
Participant Recruitment Services:
Recruitment Plan Development (no charge)
Subject Pre-screening and Referrals
Access to RPR database (no charge)
(~10,000 volunteers)
Advertising Development and Placement (no charge)
Coordinator Services:
Coordination of Protocol Procedures**
Center for Advanced Medicine (CAM) Services:
Medical Assistant Services
Research exam room use***
Specimen Packaging and Shipping
Specimen Storage (no charge)
Study Drug Administration
ECG
Phlebotomy
Other:
Please specify
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**If coordinator services are requested, we will evaluate the request based on feasibility first.
***Exam room use at CAM 11th floor research space will be charged at $15/hour for industry trials.
Regulatory and Budget Services: Full time liaison between the Principal Investigator and the Institutional Review
Board, as well as the Study Sponsor or the NIH. In addition, comprehensive budget preparation and consultation as
needed between the PI and Study Sponsor. Please contact Phyllis Klein @ 747-4289.
Participant Recruitment Services: Assistance with creating a comprehensive approach to maximizing recruitment
efforts for a clinical trial (to include creative solutions to existing and potential recruitment challenges). Access to a
volunteer database, in which potential participants can be queried by study inclusion and exclusion criteria, and pre
screened for study fit. Also, any advertising assistance, whether by print or electronic media, can be utilized. Please
contact Charles Rathmann @ 362-0897.
Coordinator Services: Many of CCS’s research coordinators are RNs and ACRP certified. We provide study
coordination from pre-site to close-out visit. The hourly rate is negotiable in accordance with your study budget.
Please contact Teresa Arb @ 747-1217.
Center for Advanced Medicine (CAM) Services: The research space is located on the 11th floor suite B. We have
5 fully equipped exam rooms in addition to 4 long-term areas for extended study visits. There are 2 areas for
phlebotomy and lab processing complete with 2 monitored freezers, 1 secured medication refrigerator as well as
centrifuges and standard lab supplies. We also have space for monitoring visits with wireless internet connection and
we maintain a fully stocked crash cart. All staff is IATA certified and RNs are ACLS certified. Please contact Ann
Doyle @ 286-1551.
Name (required):_________________
Phone (required):________________
Pager:
___________________
Email:
___________________
Name of PI: ___________________
Box # of PI: ___________________
PI signature
Study Sponsor:________________________________________
Name of Study_________________________________________
Protocol No ________________________________________
Protocol Status:
Draft
Final
Study Start Date: ________________
Study Participants:
Inpatient
Target # of patients required
date