Are you trying to register one of these sites?

Site # ICU Name Hospital Name City Country

None of these are my site

The EFFORT Study
Site Registration Form

Required fields are marked with a red asterisk (*)

For instructions on completing this form click here

User Information

  REMINDER: Each ICU must have two (2) designated study leaders in order to register.

  *  1. Primary REDCap Users
  Usernames and passwords to access the online data entry system will be assigned to each of the individuals listed below.

First name Last name Email Telephone Role in ICU Study
Leader
CV Upload
(study leaders only)
GCP Upload
(study leaders only)

Ethics Clearance

*

*



*



*


Hospital Information

*

*



*



*


 


*



*


ICU Information

*

*



*


*

*




*



*



*



*


 

*

*
(check all that apply)



*
*

*

* millilitres (ml)

*

* What range do you target?

(mmol/L = mg/dL x 0.0555)

Confirmation and Signoff

* In order to participate in this trial, sites must confirm that: