{"id":1627,"date":"2022-03-31T07:08:20","date_gmt":"2022-03-31T07:08:20","guid":{"rendered":"https:\/\/covispharma.com\/?page_id=1627"},"modified":"2024-05-24T07:04:16","modified_gmt":"2024-05-24T07:04:16","slug":"isr-concept-form","status":"publish","type":"page","link":"https:\/\/covispharma.com\/index.php\/isr-concept-form\/","title":{"rendered":"ISR Concept Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#2d81b5&#8243; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;2.5rem||5px||false|false&#8221; custom_padding_tablet=&#8221;||||false|false&#8221; custom_padding_phone=&#8221;1.5rem||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; header_font=&#8221;|600|||||||&#8221; header_text_color=&#8221;#FFFFFF&#8221; header_font_size=&#8221;3rem&#8221; header_line_height=&#8221;3.5rem&#8221; header_font_size_tablet=&#8221;2rem&#8221; header_font_size_phone=&#8221;&#8221; header_font_size_last_edited=&#8221;on|tablet&#8221; header_line_height_tablet=&#8221;2.5rem&#8221; header_line_height_phone=&#8221;&#8221; header_line_height_last_edited=&#8221;on|tablet&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>ISR Concept Form<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0px||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text content_tablet=&#8221;<\/p>\n<h2 style=%22text-align: center;%22><strong>INDEPENDENT MEDICAL EDUCATION REQUEST FORM<\/strong><br \/><strong>ACCREDITED AND NON-ACCREDITED EDUCATIONAL ACTIVITIES<\/strong><strong><\/strong><\/h2>\n<h3><em>Grant requests should be submitted to AMAG at least 60 days in advance of the scheduled event <\/em><em>and must be on institutional letterhead accompanied by an IRS Form W9, proof of accreditation: <\/em><em>(ACCME, ACPE or other) via certificate and a detailed budget and tentative agenda.<\/em><\/h3>\n<p>&#8221; content_phone=&#8221;<\/p>\n<h2 style=%22text-align: center;%22><strong>INDEPENDENT MEDICAL EDUCATION REQUEST FORM<\/strong><br \/><strong>ACCREDITED AND NON-ACCREDITED EDUCATIONAL ACTIVITIES<\/strong><strong><\/strong><\/h2>\n<h3 style=%22text-align: justify;%22><em>Grant requests should be submitted to AMAG at least 60 days in advance of the scheduled event <\/em><em>and must be on institutional letterhead accompanied by an IRS Form W9, proof of accreditation: <\/em><em>(ACCME, ACPE or other) via certificate and a detailed budget and tentative agenda.<\/em><\/h3>\n<p>&#8221; content_last_edited=&#8221;off|desktop&#8221; module_id=&#8221;press-title&#8221; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_font_size=&#8221;1.1rem&#8221; text_line_height=&#8221;1.75rem&#8221; header_2_font=&#8221;Montserrat|500|||||||&#8221; header_2_text_align=&#8221;center&#8221; header_2_font_size=&#8221;1.3rem&#8221; header_2_line_height=&#8221;1.6em&#8221; header_3_text_align=&#8221;center&#8221; header_3_text_color=&#8221;#2d81b5&#8243; header_3_font_size=&#8221;1em&#8221; header_3_line_height=&#8221;1.5em&#8221; header_4_line_height=&#8221;1.5em&#8221; header_2_text_align_tablet=&#8221;center&#8221; header_2_text_align_phone=&#8221;justify&#8221; header_2_text_align_last_edited=&#8221;on|phone&#8221; header_2_font_size_tablet=&#8221;1.3rem&#8221; header_2_font_size_phone=&#8221;1.1rem&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; header_3_font_size_tablet=&#8221;1em&#8221; header_3_font_size_phone=&#8221;0.9rem&#8221; header_3_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 style=\"text-align: center;\"><strong><span>COVIS INVESTIGATOR SPONSORED RESEARCH CONCEPT FORM<\/span><\/strong><strong><\/strong><\/h2>\n<h3 style=\"text-align: center;\"><i>Covis Pharma is committed to advancing science by supporting external independent research activities.<\/i><\/h3>\n<p>[\/et_pb_text][et_pb_text module_id=&#8221;press-title&#8221; _builder_version=&#8221;4.24.0&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_font_size=&#8221;1.1rem&#8221; text_line_height=&#8221;1.75rem&#8221; header_2_font=&#8221;Montserrat|500|||||||&#8221; header_2_font_size=&#8221;1.3rem&#8221; header_2_line_height=&#8221;1.4em&#8221; header_3_text_color=&#8221;#2d81b5&#8243; header_3_font_size=&#8221;1.1em&#8221; header_3_line_height=&#8221;1.5em&#8221; header_4_line_height=&#8221;1.5em&#8221; text_orientation=&#8221;justified&#8221; custom_margin=&#8221;||0px||false|false&#8221; custom_padding=&#8221;||||false|false&#8221; hover_enabled=&#8221;0&#8243; text_font_size_tablet=&#8221;1.1rem&#8221; text_font_size_phone=&#8221;1rem&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p><strong>Specific areas of interest related to respiratory diseases (Asthma &amp; COPD):<\/strong><\/p>\n<ul>\n<li>Research related to special or new patient populations for ciclesonide, aclidinium bromide, and aclidinium\/formoterol combination<\/li>\n<li>Research related to new novel combinations of corticosteroids for inhaled diseases (e.g., ciclesonide with other mechanisms [not LAMA or LABA])<\/li>\n<\/ul>\n<p><strong>Specific areas of interest related to Magnetic Resonance Imaging or ferumoxytol:<\/strong><\/p>\n<p><strong><\/strong><\/p>\n<ul>\n<li>Ferumoxytol in various biomedical applications, including diagnosis, therapy and theragnostics<\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text module_id=&#8221;press-title&#8221; _builder_version=&#8221;4.17.4&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_font_size=&#8221;1rem&#8221; text_line_height=&#8221;1.75rem&#8221; header_2_font=&#8221;Montserrat|500|||||||&#8221; header_2_font_size=&#8221;1.3rem&#8221; header_2_line_height=&#8221;1.4em&#8221; header_3_text_color=&#8221;#2d81b5&#8243; header_3_font_size=&#8221;1.1em&#8221; header_3_line_height=&#8221;1.5em&#8221; header_4_line_height=&#8221;1.5em&#8221; text_orientation=&#8221;justified&#8221; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;||||false|false&#8221; text_font_size_tablet=&#8221;1.1rem&#8221; text_font_size_phone=&#8221;1rem&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: justify;\"><span>Additional related topics may also be considered. Research studies may include clinical studies, epidemiology, and\/or database driven evaluations, and preclinical <em>in vivo<\/em> and <em>in vitro<\/em> designs.<\/span><\/p>\n<p>[\/et_pb_text][et_pb_text module_id=&#8221;press-title&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_font_size=&#8221;1.1rem&#8221; text_line_height=&#8221;1.75rem&#8221; header_2_font=&#8221;Montserrat|500|||||||&#8221; header_2_font_size=&#8221;1.3rem&#8221; header_2_line_height=&#8221;1.4em&#8221; header_3_text_color=&#8221;#2d81b5&#8243; header_3_font_size=&#8221;1.1em&#8221; header_3_line_height=&#8221;1.5em&#8221; header_4_line_height=&#8221;1.5em&#8221; text_orientation=&#8221;justified&#8221; text_font_size_tablet=&#8221;1.1rem&#8221; text_font_size_phone=&#8221;1rem&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: justify;\">For healthcare professionals interested in a preliminary evaluation of potential Covis support for independently conducted research studies, please respond to the questions below. Note: Covis will not provide comments or suggestions to study design or protocol.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.16.1&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1630-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1630\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1627#wpcf7-f1630-o1\" method=\"post\" class=\"wpcf7-form init wpcf7-acceptance-as-validation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1630\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1630-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:1630,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;}}\" \/>\n<\/div>\n<div class=\"one-half\">\n\t<p><label> Investigator Name\/Institution:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"investigator-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"investigator-name\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"one-half last\">\n\t<p><label> Email Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-136\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Click of tap here to enter text.\" value=\"\" type=\"email\" name=\"email-136\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<p><label> Objective:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"objective\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"objective\" \/><\/span> <\/label>\n<\/p>\n<p><label> Study Design:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"study-design\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"study-design\" \/><\/span> <\/label>\n<\/p>\n<p><label> Sample Size (if applicable):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sample-size\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"sample-size\" \/><\/span> <\/label>\n<\/p>\n<p><label> Anticipated Time to Completion:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"anticipated-time\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"anticipated-time\" \/><\/span> <\/label>\n<\/p>\n<p><label> Request for Study Medication (If yes, estimate amount):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"request-for-sm\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"request-for-sm\" \/><\/span> <\/label>\n<\/p>\n<p><label> Estimated Budget (a detailed budget will be required for formal submission and review):<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"estimated-budget\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Click or tap here to enter text.\" value=\"\" type=\"text\" name=\"estimated-budget\" \/><\/span> <\/label>\n<\/p>\n<h3 class=\"pleaseUpload\">Please upload:\n<\/h3>\n<p>1. Detailed Budget Summary\n<\/p>\n<p>2. Principal Investigators\u2019 CV\n<\/p>\n<div class=\"doc-upload\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"files-upload-2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-drag-n-drop-file d-none\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" multiple=\"multiple\" data-name=\"files-upload-2\" data-type=\"pdf|docx|doc|png|jpeg|jpg\" data-limit=\"52428800\" data-min=\"1\" data-max=\"2\" data-id=\"1630\" data-version=\"free version 1.3.9.8\" accept=\".pdf, .docx, .doc, .png, .jpeg, .jpg\" \/><\/span>\n\t<\/p>\n<\/div>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-911\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-911\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I have read and accept the <a href=\"\/index.php\/privacy-policy\/\" target=\"_blank\">Privacy Policy<\/a><\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text module_id=&#8221;press-title&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; text_font_size=&#8221;1.1rem&#8221; text_line_height=&#8221;1.75rem&#8221; header_2_font=&#8221;Montserrat|500|||||||&#8221; header_2_font_size=&#8221;1.3rem&#8221; header_2_line_height=&#8221;1.4em&#8221; header_3_text_color=&#8221;#2d81b5&#8243; header_3_font_size=&#8221;1.1em&#8221; header_3_line_height=&#8221;1.5em&#8221; header_4_line_height=&#8221;1.5em&#8221; text_orientation=&#8221;justified&#8221; text_font_size_tablet=&#8221;1.1rem&#8221; text_font_size_phone=&#8221;1rem&#8221; text_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p style=\"text-align: justify;\">Covis Medical Affairs will notify you if the topic does, or does not, fit into an area of research that we would like to evaulate further. If there is initial interest, a formal submission of the full ISR application, which would be provided, protocol or at least synopsis of work to be conducted and detailed budget (if applicable) will be required. Approval of submissions is based on scientific merit, feasibility, alignment to the company&#8217;s strategic focus, and budget considerations, and are not intended to be an inducement or payment for referral of or recommending referral of patients for any Covis product.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ISR Concept FormCOVIS INVESTIGATOR SPONSORED RESEARCH CONCEPT FORM Covis Pharma is committed to advancing science by supporting external independent research activities.Specific areas of interest related to respiratory diseases (Asthma &amp; COPD): Research related to special or new patient populations for ciclesonide, aclidinium bromide, and aclidinium\/formoterol combination Research related to new novel combinations of corticosteroids for [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-1627","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/pages\/1627"}],"collection":[{"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/comments?post=1627"}],"version-history":[{"count":0,"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/pages\/1627\/revisions"}],"wp:attachment":[{"href":"https:\/\/covispharma.com\/index.php\/wp-json\/wp\/v2\/media?parent=1627"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}