Probiotics QI Project Enrollment Form
Email address *
Probiotics Quality Improvement Project Information
The goal of this quality improvement initiative is to monitor differences in key outcomes after adoption of routine use of different promising probiotic products. For full QI project information, please visit: http://wp.me/P4gMc7-EJ4

Once this form is completed, you will be contacted to confirm your enrollment and will be provided with a unique NICU study number.

Enrollment Information
Name of NICU/Medical System
Your answer
Location of NICU (City & State/Province)
Your answer
Name and email of neonatologist overseeing this QI project
Your answer
Name and email of individual inputting data for this QI project
Your answer
Which probiotic product will be administered? L reuteri, B infantis, Florababy, or other (please list)
Your answer
Start date of probiotic administration
MM
/
DD
/
YYYY
Thank you for participating in this Quality Improvement project!
For any questions, please contact Dr. Mark Underwood at munderwood@ucdavis.edu
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