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conflict of interest disclosure form - Noguchi Memorial Institute for ...

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<br />

<br />

<br />

Why is this study being closed? (Check one)<br />

Data analysis complete<br />

Interim analysis determined study is not safe or efficacious<br />

<br />

No funding, time constraints or personnel to do the study<br />

Others (Please explain)<br />

_______________________________________________________________<br />

NB: A cover letter requesting <strong>for</strong> closure <strong>of</strong> study and a 2-3 page detailed final report should be<br />

attached to the study closure <strong><strong>for</strong>m</strong>. The report should have an introduction, methodology, final<br />

results, discussion, a section stating whether or not the study objectives have been made,<br />

recommendations, conclusions and conclusion<br />

__________________________________<br />

Signature <strong>of</strong> Principal Investigator<br />

__________________________________<br />

Date<br />

NMIMR IRB Study Closure Form 2

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