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Click ‘Get Form’ to open the FIH Medical Officer: document in the editor.
Begin by filling in the tournament name, dates, and venue at the top of the form. This sets the context for the medical incident report.
In the 'Team' section, enter the name of the team involved. Then, provide details about the injured player including their name, gender, and shirt number.
Document the date and location of the incident. In the 'Description of incident' field, describe what happened and any known mechanisms of injury.
Fill in the diagnosis section with relevant medical information. If hospitalization occurred, complete that section with hospital details and attending doctors.
Provide a summary of any surgeries or procedures performed along with discharge details.
For follow-up plans, specify which doctor will oversee recovery, where they are located, and any necessary disposition needs such as mobility aids or rehabilitation requirements.
Finally, add any further comments if needed and ensure to sign and date at the bottom before submitting your report.
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Nov 12, 2019 Dr. Ramya Gopinath, MD Medical Officer Division of Anti-Infective Products Center for Drug Evaluation and Research, First-in-Human (FIH) trials
Study Details | NCT07255664 | A FIH, Phase I/IIa, Trial
Note: Patients may be eligible if they have been assessed in discussion between Principal Investigator, Chief Medical Officer and Senior Medical Consultant asRead more
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