Home
Opleiding & onderzoek
Klinische studies
Formulier CTC

Formulier CTC

Declaration of Experiment in AZ Sint-Lucas Brugge

General information

Type of declaration

*Retrospective studies and case reports only using existing data or an existing database

Prospective study (not CTR/ MDR/ IVDR)

Prospective study (CTR/ MDR/ IVDR)

Retrospective study*

Other (For bachelor/master thesis, read more: Eindwerk - AZ Sint Lucas)

read more: Eindwerk - AZ Sint Lucas

Clinical relevance

Feasibility of the trials including suitability of the infrastructure

Financial agreement between sponsor and investigator/hospital

Yes

Details

Participation of children or patients unable to give consent

Yes

Participation of patients in emergency situations

Yes

Payment

€ 164,21 (exclusief btw) voor commerciële niet-interventionele studies € 492,57 (exclusief btw) voor commerciële interventionele studies In order for the hospital to provide a correct invoice, please give the correct invoice details to the EC

Study name

Protocol number

Principal Investigator at AZ Sint Lucas Brugge

Site number

Study reference

Invoice address

VAT number

Email address

Company contact person

For the submission of your study to our local ethics comité, please send an email to ethisch.comité@stlucas.be including following documents

Protocol
Investigator's Brochure
Informed consent (Dutch)
Patient information and questionnaires
Protocol Synopsis (Dutch)
EudraCT Application form
CV local investigator
CV national investigator
GCP certificates investigators
Contract
Insurance document
Advice of FGOV (medical devices)
Checklist EC AZ Sint-Lucas
Invoice Information

AZ St-Lucas specific information

Please select all AZ Sint-Lucas departments/disciplines that will be involved in the trial

for contact details, click here

Coordination of clinical trials

Nursing support

Pharmacy

Laboratory

Radiology

Pathology

Cardiology

There will be no need for support from personnel or services from AZ Sint-Lucas Brugge.

Other

for contact details, click here

namelijk:

Processing by

External Lab

AZ Sint-Lucas Lab

Pharmacy request form

Laboratory request form

Radiology request form

Pathology request form

Anticipated Start date at AZ Sint-Lucas Brugge

Anticipated End date at AZ Sint-Lucas Brugge

Expected number of patients included at AZ Sint-Lucas Brugge

Is a CRO involved:

Yes

Name CRO

Street

Number

Town

Postal code

Country

Contact person

Name

Phone number

Contact person for negotiation

Name

Phone number

Contact person for invoicing

Name

Phone number

Zorgaanbod

Artsen

Info voor patiënten

Bezoektijden

Wegwijs

Vacatures

AZ Sint-Lucas Brugge

Sint-Lucaslaan 29
8310 Brugge
Ondernemingsnummer 0408.116.216

info@stlucas.be
Algemeen 050 36 91 11
Spoed 050 36 91 12

Patiënten

Zorgaanbod
Artsen
Raadpleging
Ziekenhuisopname
Dagziekenhuis

Bezoekers

Op bezoek
Bistro & automatenshop

Zorgprofessionals

Voor zorgverleners
Studenten

Over ons

Wegwijs

Steun het ziekenhuis

Jobs

Contact

Disclaimer - Sitemap

Home
Patiënten
Bezoekers
Zorgprofessionals
Opleiding & onderzoek
Jobs
Over ons
Nieuws & events
Contact
Contact
Spoed 050 36 91 12
Algemeen 050 36 91 11

Formulier CTC

Declaration of Experiment in AZ Sint-Lucas Brugge

Cookie instellingen