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About
What is GIQuIC?
How Does GIQuIC Work?
What Does GIQuIC Measure?
GIQuIC Pricing
GIQuIC News
FAQ
Join GIQuIC
Current Participation
Benefits of Participation
Case Studies/Testimonials
Current Participants
GIQuIC Data Manager Role/Training
Merit-based Incentive Payment System (MIPS)
GIQuIC Quality Audit
Physician Resources
Data Manager Resources
Research
Research Overview
GIQuIC Research Policies & Procedures
ACG/ASGE Epidemiologic Research Award
GIQuIC Research Publications
Research FAQ
Quality Reporting Programs/MIPS
GIQuIC QCDR/MIPS
2024 Reporting Year
RESEARCH REQUEST PRE-PROPOSAL
"
*
" indicates required fields
REQUESTOR NAME:
*
First
Last
REQUESTOR EMAIL:
*
REQUESTOR INSTITUTION OR ORGANIZATION:
*
CO-INVESTIGATOR(S) NAME(S):
CO-INVESTIGATOR(S) INSTITUTION OR ORGANIZATION(S):
ARE YOU A MEMBER OF ACG?
Yes
No
ARE YOU A MEMBER OF ASGE?
Yes
No
TENTATIVE TITLE OF PROPOSAL:
FUNDING SOURCE:
ASGE
ACG
Other Society
NIH / Federal Grant
Industry Sponsor
Personal / Internal Funds
Other
Funding Source Not Yet Identified
PROJECT PURPOSE and SPECIFIC AIMS:
Pilot Data
Preparatory to Grant Submission
Journal Publication
Industry Use
Other
Other text
ARE THERE ANY DEADLINES FOR RECEIVING RESULTS FROM THIS REQUEST? IF SO, PLEASE DESCRIBE:
HYPOTHESES TO BE ADDRESSED:
Colonoscopy
EGD
DATA REQUESTED:
MM slash DD slash YYYY
STUDY DATE RANGE:
LIST MAIN VARIABLES OF INTEREST:
EXPECTED RESULTS:
PLAN FOR DISSEMINATION: