The UNIFIED Project Team thank you for your interest in our project.

Before completing this application form, make sure you have carefully read the Call for Expressions of Interest. This will help you prepare your answers and the required information/documents.

The information gathered in this form will help us understand better your profile and background. EPF will use the information you provide to assess your application. You can view EPF's privacy policy here. We are keen to hear from people with different experiences and varying levels of knowledge about the subject matter.

Should you have any questions, comments or concerns for this survey, please feel free to reach out to EPF Projects Officer Bianca Pop at bianca.pop@eu-patient.eu and EPF Capacity Building Officer Borislava Ananieva at borislava.ananieva@eu-patient.eu.

We look forward to working together on this worthwhile and ambitious project.

Best of luck with your application!

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your date of birth?

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* 4. What is your email address?

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* 5. What is your permanent address?

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* 6. What condition/treatment do you represent?

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* 7. What is your gender?

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* 8. What is your level of English?

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* 9. What other languages do you speak?

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* 10. Have you previously participated in a Patient Advisory Group for any EU-funded project?

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* 11. If you have previously participated in Patient Advisory Groups for an EU-funded project, please briefly describe the project and your role in it (if you haven't you can write N/A).

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* 12. Have you ever participated in Patient Preference Studies (PPS)* or contributed to research involving Patient Preference Information (PPI)** or other Clinical Outcome Assessments (COAs)**?
*PPS - research methods that investigate what matters most to patients in healthcare decisions.
**PPI - Data on what matters most to patients when choosing or evaluating health treatments and devices, including their values on benefits, risks, side effects, convenience, and quality of life impacts, moving beyond just clinical outcomes to support shared decision-making and regulatory reviews.
***COAs - measures capturing how a patient feels, functions, or survives, showcasing treatment benefits from a patient's perspective.

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* 13. If yes, please briefly describe your experience or knowledge (if you haven't you can write N/A).

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* 14. Do you have an understanding and/or experience with digital health technologies (DHTs)? (e.g., wearable devices, mobile health apps for tracking symptoms or medication, telehealth platforms, or virtual care tools) *

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* 15. Have you or a family member ever used digital health technology? (e.g., wearable devices, mobile health apps for tracking symptoms or medication, telehealth platforms, or virtual care tools) *

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* 16. If you (or a family member) have used DHTs, please specify what type (Max. 100 words):

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* 17. As a Patient Representative of the Patient Advisory Group, what category applies to your situation?

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* 18. If you are affiliated with a patient organisation, which one is it?

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* 19. Why are you interested in joining the IHI-UNIFIED Patient Advisory Group? (Max. 300 words)

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* 20. Are there any potential barriers (physical or unseen) that might prevent you from participating?

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* 21. If I am selected, I will participate in the project’s annual meetings (maximum of three PAG members can be invited and reimbursed per General Assembly meeting), contribute to regular Patient Advisory Group meetings and other relevant meetings, and provide input and feedback to project consortium members where needed.

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* 22. If I am selected, my participation will depend on the activities, topics, dates, and relevance of the IHI-UNIFIED Project *
*Mandatory commitment of 4 yearly online meetings, with a possibility of 2 ad-hoc online meetings every year (based on the project’s needs), including meeting pre-reading material.

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* 23. Please attach your CV to your application (max 2 pages, PDF or MS Word).

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* 24. Do you have any actual, potential, real, or apparent conflict of interest to declare? (e.g., affiliation with regulatory authorities such as EMA, affiliation with the pharmaceutical industry etc.)

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* 25. I declare my word of honor that the information provided above is true and complete. I understand that any misrepresentation in supplying this information may lead to my exclusion from the present call.

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* 26. I agree and sign the declaration of interest by clicking the "Done" button at the end of this application.

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