Ghana Police Hospital
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IRB Reference Number
Title of Study
Principal Investigator
Institution / Affiliation
Original Date of Ethical Approval
Current Approval Expiry Date
Request for Continuing Review / Renewal
Selected
Study Closure (Completed as approved)
Early Termination (Stopped before completion)
3.1 Summary of Study Progress to Date
3.2 Number of Participants Approved vs Enrolled
3.3 Summary of Any Deviations from Approved Protocol
3.4 Summary of Adverse Events or Unanticipated Problems (If Any)
3.5 Assessment of Ongoing Risk-Benefit Balance
No Amendments
Amendments Submitted and Approved
Attach Amendment Details
Requested Continuation Period
6.1 Date of Study Completion or Termination
6.2 Reason for Early Termination (If Applicable)
6.3 Confirmation that no further participant contact or data collection will occur
Yes
No
6.4 Summary of Final Outcomes (Brief)
Describe plans for final data storage, confidentiality and dissemination of results
I certify that the information provided in this report is accurate and complete. I confirm that the study has been conducted in accordance with the approved protocol and ethical requirements and that the IRB has been notified of study completion or termination.
Name of Principal Investigator
Signature
Date
[uacf7-row] [uacf7-col col:12] [/uacf7-col] [/uacf7-row]
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