Improving Patient Care in Uncontrolled Acromegaly (IPCUA)
Grant Application Form
Project Title
Healthcare Organisation and Full Address
Name/ Contact details for IndividualRequesteron behalf of Healthcare Organisation* / Name:
Role/position:
Email:
Contact phone number:
Project Goal / Briefly describe how this project will improve patient care
Project Plan / Please outline the proposed methodology and key stages/milestones of your planned approach. Please include details of responsible roles required to carry out the project, e.g. in house staff, external service providers.
EvaluationMeasures and Metrics / What measures and metrics will you use to evaluate the success of the project
Ensure robust plan to capture baseline and end of project metrics e.g.
  • Identification of baseline numbers of uncontrolled acromegaly patients
  • Change in numbers of uncontrolled acromegaly patients
Please note Pfizer must not receive any patient identifiable information
Educational Sustainability / How will the project support ongoing patient management and care?
Start and End Date
RequestedSupport from Pfizer / Please indicate total monetary sum being requested from Pfizer and provide a full breakdown of how the funding will be spent* e.g.
  • Number of additional clinics to be provided
  • Hourly rates of required personnel
  • Costs of Consumables
  • Number and cost of educational materials to be printed
If any additional non-monetary support is required please detail here.
*Please note funding for institutional overheads will not be provided

PP-GIP-GBR-2220IPCUA Grant Application FormDate of preparation Aug 2017

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