Ā鶹“«Ć½

U.S. flag

SHARE:

FacebookTwitterEmail AHRQPrint

PBRN Registration Form

Asterisk for required fields Asterisk denotes required fields

PBRN Organization Information

To register as a Primary Care Practice-Based Research Network, a PBRN should meet the following conditions: 
ā€¢    A minimum of 50% of the membership are primary care clinicians (e.g., pediatrics, family medicine, general internal medicine, and geriatrics);
ā€¢    A minimum of 5 practice locations and 15 clinicians are engaged; and 
ā€¢    A Director and a Mission Statement are formally adopted.
PBRNs may register if they are established primary care PBRNs (meet the above criteria) or are in the process of organizing as a primary care PBRN.
PBRNs whose members consist of less than 50% primary care clinicians are registered as Affiliate PBRNs (examples include Pharmacy and Dental PBRNs).

PBRNs based outside of the United States are welcome to register with AHRQ as affiliate members.

Based on the information provided, please select the Network Category for your PBRN. Asterisk for required fields

(Include http:// or https:// in the URL)

PBRN Organization Points of Contact

In addition to the PBRN Director, PBRN/Registry Administration Point of Contact, and Principal Investigators, up to three additional contacts can be listed for the PBRN. 

PBRN Organization Details

Practice/Clinic Location(s) for this PBRN (Select all that apply.)
Current or Past Research Interests/Health Conditions (Select all that apply.)
Does your PBRN have any affiliations? (Select all that apply and use the ā€œAffiliation Notesā€ to specify or name the affiliation)
CAPTCHA
Image CAPTCHA
Enter the characters shown in the image.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.