Please answer the following questions based on all providers who will be participating in this research and the practice's collective demographics, not solely on those of the individual completing the survey.

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* 1. General Information

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* 2. The Principal Investigator is a

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* 3. Site Facility Information
What is the site/facility type that would be used for this registry?

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* 4. Please enter the total number of staff that would be available to support this research project at your site. Please enter a numerical value for each type of staffing resource below:

Total Number of Providers:

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* 5. Is any of your research staff a certified research professional?

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* 6. In what ways do you use clinical support staff to help you conduct research? Check all that apply.

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* 7. Will your site be managed by a SMO for this study?

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* 8. Will a full-time dedicated Primary Research Coordinator be assigned to the Corrona Psoriasis Registry?

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* 9. Will a Back-up Coordinator be assigned to the Corrona Psoriasis Registry?

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* 10. Institutional Review Board

If your site uses a local IRB, would your local institutional review board (IRB) be willing to issue a waiver of jurisdiction to allow Corrona’s central IRB (NEIRB, IntegReview or WIRB) to review and govern the protocol at your site?

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* 11. Reason For Participation

Which are your reasons for wanting to participate in a Corrona Registry? Please check all that apply.

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* 12. In order for Corrona to yield valid research results and for your site to be considered for additional research opportunities, this requires enrollment of the majority of eligible patients in your practice. Are you able to do this?

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* 13. Subject Population

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* 14. Has your site previously participated in a clinical trial?

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* 15. Has your site previously participated in a registry?

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* 16. If Yes, please provide the following information regarding the PI’s experience conducting clinical trials and/or registries:

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* 18. Do you have a dedicated recruitment specialist at your site?

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* 19. What specific recruitment strategies have you employed in the past that proved to be successful?

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* 20. Technology Available

What is the current EMR system in use at your office?

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* 21. Is there any plan to switch to another EMR in the next 12 months?

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* 22. Referral

How did you learn about the Corrona Psoriasis registry?

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* 23. Do you know of other dermatologists that may be interested in participating in the Corrona Psoriasis Registry?

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* 24. Please provide name and contact information of person completing this survey below

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