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INTUBE study - Call for center form
Please fill in this form completely and press the "send" button at the end of this page (one application for each institution).
Email address *
INternational observational study To Understand the impact and BEst practices of airway management of critically ill patients
Institution name *
Your answer
Type of hospital
Department *
Your answer
Address *
Your answer
Post code *
Your answer
City *
Your answer
Country *
Your answer
Number of ICUs of your institution
Your answer
Total number of ICU beds
Your answer
How many in-hospital endotracheal intubations of critically ill patients are performed in your institution in a week?
Principal investigator
Title
Last name *
Your answer
First name *
Your answer
Date of birth
MM
/
DD
/
YYYY
Office phone
Your answer
Mobile phone
Your answer
E-mail *
Your answer
Second contact person
Title
Last name
Your answer
First name
Your answer
E-mail
Your answer
I give my permission to publish my center name on the INTUBE study website (www.intubestudy.com) *
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