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Name of Sponsor / Sponsor-Investigator
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Full title of protocol
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Short title of protocol or Study ID, if applicable
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The version number and the date of the valid study protocol
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Provide the name of the study registry and the registration number and date (if not registered then indicate the anticipated registry)
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Provide the determined study category with explanation for this category
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For clinical trials with drugs: Clinical study phase or phase of clinical development (e.g. Phase 1, 2, 3 or 4; or according to ICH E8 para 3.1.3 Human Pharmacology, Therapeutic Exploratory, Therapeutic Confirmatory or Therapeutic Use); in case of Medical Device study rename and use e.g. “Phase of development”
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Provide a short background and the rationale for the study, this includes the health condition studied
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Brief statement of primary study objectives and the main secondary study objectives.
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Brief statement of primary study outcome and the main secondary study outcome measures.
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Design attributes such as open label; randomised, placebo or active control; cross-over design, etc.
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Brief description of the anticipated study population, the key inclusion and exclusion criteria and if applicable, the reasons for inclusion of vulnerable participants
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Describe the study intervention (methodology, procedures, sampling if applicable)
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Describe the study specific intervention (product (drug / device name (generic), dose, route, regimen) used in the study). Duration of product administration (also run-in if applicable)
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Describe if applicable the comparator(s) (e.g. active control, reference therapy, placebo)
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Number of participants projected for the entire study (e.g. not for simply one site, rather for entire study, all sites combined). Give the total and the numbers for each treatment group
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Estimated duration for the main investigational plan (e.g. from start of screening of first participant to last participant processed and finishing the study)
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Month Year of First-Participant-In (planned)
Month Year of Last-Participant-Out (planned)
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Name(s) of Investigator(s)
Full contact details
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Single-centre or multi-centre. If multi-centre note number of projected centres to be involved. Or countries if multi-national study
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A very brief description of the main elements of the statistical methodology to be used in the study. Explanation to sample size
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This study will be conducted in compliance with the protocol, the current version of the Declaration of Helsinki, the ICH-GCP or ISO EN 14155 (as far as applicable) as well as all national legal and regulatory requirements. *
GCP Statement
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Insurance (yes/no)? Sum?
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