Clinsole - CLINConnect

“CLINConnect” a Site Network

Clinsol network of clinical research sites today are in 25+ sites in 5 states and adding continually.

We are building alliances of clinical trial research sites PAN India. And our partners gain access to our large and efficient network of sites. We offer our partners a convenient solution for expedited site identification and study start-up, and we bring efficiencies by enabling “1CBC” model - “Single Contract, Single Budget and Single point of Contact.

Clinsol mission is to enhance the quality of trials conduct by partnering and provides the cost-effective methods combined with performance driven history while maintaining the highest level of quality of research.

Clinsol host investigators annual meet set expectation and provides industry standards knowledge. Our networked, experienced investigators are another value-added service to the benefit from when partnering with Clinsol.

We partnerships with sponsors and our focus is on the conduct of on time, high-quality Phase I – IV clinical trials of drugs and devices trials.

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Principle Investigator Details:

Sub Investigator Details:

Name of Sub Investigator:

Institution Name & Address:

Country

State

City

Contact Number

MRC Reg No:

E-mail:

Preferable time for contact:

Qualification:

Specialization:

Number of ongoing clinical trial projects (As an Investigator) and Clinical Research Experience (Till Date)

0 1 2 3 >4

S. No	Trial Phase	Total No. of Trial Participated (Indian & Global)	No. of Trial Global/Indian)	Therapeutic Indication	Role in the Study	Status (Ongoing/Completed)

CRC Details:

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Institution Name:

Address

Country

State

City

Institution Type

Government Hospital

Private Hospital

No of beds

Type of Hospital

Multi Specialty

Non-Multi Specialty

NABH Hospital

Section 1.0

Primary Contact Details

Name

Designation

Contact Number

E-mail ID:

Section 2.0

List of Interested Doctors/Investigators

Sr.	Therapeutic Area	Available in Hospital	*Name of Doctor/Investigator

Oncology

Yes No

Dermatology

Yes No

Neurosciences (Psychiatry)

Yes No

Respiratory

Yes No

Orthopedic

Yes No

Gastroenterology

Yes No

Ophthalmology

Yes No

Gynecology

Yes No

General Medicine

Yes No

Others

Yes No

Others

Yes No

Others

Yes No

Section 3.0

Site Infrastructure Details

Instrument	Available	Calibrated	Instrument	Available	Calibrated

Deep Freezer-20°C

Yes No

Deep Freezer-70°C

Yes No

Normal Centrifuge

Yes No

Cooling Centrifuge

Yes No

Refrigerator

Yes No

ECG

Yes No

Weighing Scale

Yes No

Stature Meter

Yes No

Respiratory monitor

Yes No

Weighing Balance

Yes No

BP apparatus

Yes No

2D ECHO

Yes No

CT scan

Yes No

X-ray

Yes No

Height Meter

Yes No

Pulse Oximeter

Yes No

MRI

Yes No

Endoscopy

Yes No

Ultrasound

Yes No

Hygrometer

Yes No

Available Facility at Site

Photocopier

Yes No

Printer

Yes No

Computer/Laptop

Yes No

Internet

Yes No

Cupboard

Yes No

STD/ISD Facility

Yes No

Fireproof Drug Storage Area

Yes No

Fax Facility

Yes No

Separate space for Documentation

Yes No

Fireproof Storage/ Archival Area

Yes No

Facility for Audio Visual Recording

Yes No

Separate Room for Monitoring

Yes No

Power Backup

Yes No

Site Specific SOP /Process

Yes No

Storage Facility

Yes No

Fire Alarm

Yes No

Others

Yes No

Centralized Ac

Yes No

Available Investigation Facility at Site

Facility	Status	MOU Available (If External)	Accredited	Accreditation (NABL, CAP, ISO)

Pathology Laboratory

Internal External

Yes No

Radiological Investigations

Internal External

Yes No

Intensive Care Unit (ICU)

Internal External

Yes No

Emergency Unit

Internal External

Yes No

Staff Details (If Applicable)

Total No. of CRC

Full Time

Yes No

Total No. of Study Nurse

Total No. of Study Pharmacist

Total No. of Phlebotomist

Total No. of Psychologist

GCP Trained

Yes No

Experience

Yes No If yes Year

Section 4.0

Department Details

Site Audited by any Regulatory Authority / by Sponsor Yes No

Name of Regulatory:

Engagement with any professional SMO

Yes No

Bio-Waste Destruction Facility Available

Yes No

Patient database maintenance at site

Yes No

Medical Record Department

Yes No

Satellite Site (Facility)

Yes No

Section 5.0

Ethics Committee (EC) Details

Ethics Committee Institutional

Yes No

Ethics Committee Independent

Yes No

Ethics Committee SOP Available

Yes No

Ethics Committee Registered with CDSCO

Yes No

EC Registration Number

Registration Due Date

Scientific Committee at your Site

Yes No

EC Fees Amount in INR

Including GST Excluding TDS

EC Fees Cheque to be made in Favor of

Hospital Overhead Charges (If Any)

Including GST Excluding TDS

Section 6.0	*Interested Doctors/Investigators Details
Name:		Qualification:
Therapeutic Area:		Designation / Affiliation with Institute:
Contact Number:		E-Mail ID:
MRC Reg No:
Experience in Clinical Trial:	Yes No	Experience in PK/PD:	Yes No
Preferable Time to Contact:		Associated with any Company /Advisory Committee:	Yes No

Previous Trials Experience Details
Sr. No.	Disease	Drug Name/Device Name	Phase	Role	Completed/Ongoing	Regulatory Status
1				PI Co-I
2				PI Co-I
3				PI Co-I
4				PI Co-I
5				PI Co-I
6				PI Co-I
7				PI Co-I

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Name

Email Address

Country

State

City

Phone No

Gender

Male

Female

Date of Birth

Weight

Height

Why you want to participate in the clinical trial?

Previously participated in clinical trial:

Yes

If yes, please share when you had participated:

54+

Completed Projects

16+

Sites

80+

Networked Principal Investigator

19+

Therapeutic Area

Is site having Study Coordinator:	Yes No
If Yes, provide below details:
Is the Study Coordinator working full time at the trial site	Yes No
Name of Study Coordinator:
Contact Number
E-mail:
Qualification:
Years of Experience:
Number and phase of clinical trial conducted so far	0 1-5 6-10 11-20 >20 Phase 1 Phase 2 Phase 3 Phase 4 Other ( Non regulated)
Training obtained	ICH-GCP Other – please specify below:(If yes please mention the latest year of training certification and certification body)