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The Pain, Spine, and Sports Institute NEW PATIENT INTAKE FORMER PATIENT INTAKE Forename:DOB:/!/SSN:! Age:Sex:Marital Status: S M WD Height:Phone #: ()Zip:Cell #: (! Weight:City/State:Address:!)! Email: Occupation: Referred
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Organize the gathered information and data into a clear and concise format.
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Write a detailed summary of the safety profile, including any adverse events or side effects that have been observed.
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Summarize the efficacy data, highlighting any positive outcomes or changes in patient outcomes.
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Include any relevant statistical analysis or clinical trial results.
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Who needs expanded safety and efficacy?

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Patients and their caregivers
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Expanded safety and efficacy refers to the comprehensive evaluation of a product's safety and effectiveness beyond initial clinical trials, often involving larger or more diverse populations.
Typically, pharmaceutical companies and sponsors of clinical trials who are seeking approval for new drugs or therapies are required to file expanded safety and efficacy.
Filling out expanded safety and efficacy involves compiling relevant clinical data, safety monitoring reports, and efficacy analysis, and submitting them according to regulatory guidelines outlined by health authorities.
The purpose of expanded safety and efficacy is to ensure that a product is safe for public use and effective in its intended application before full approval is granted.
Information that must be reported includes adverse event data, demographic and clinical characteristics of the study population, and detailed efficacy outcomes from the trials.
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