ICMR
Online Application Form
MedTech Mitra
Handholding MedTech Innovators for Clinical Evaluation, Regulatory Facilitation and Uptake of New Products
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1. Consent
I
hereby give my permission to ICMR to share personal information with relevant stakeholders associated with MedTech Mitra and understand that ICMR may hold information gathered about me through the portal and as such my rights under The Digital Personal Data Protection Act, 2023 will not be affected.
2. Contact Information
Name of the Innovator(s)
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Name of Company/Institute
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Email ID
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Applicant Type
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Select Any One
Company
Startup
Institute
Individual
Contact Number
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MedTech Innovation Type
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Select Any One
Medical Device
In-vitro Diagnostic
Therapeutic/Vaccine
3. MedTech Innovation Information
Name of the Technology
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Intended Use Statement
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Target Population
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Select Any One
Paediatric
Men
Women
Elderly
Pregnant Women
Risk Classification of Medical Device / IVDs (As per Medical Device Rules, 2017)
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Class A
Class B
Class C
Class D
Not Known
Summary of The Technology
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Type of Medical Device/Diagnostic
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Select Any One
Investigational Medical Device/IVD
Medical device/IVD having available predicate device/diagnostic
Use Environment
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Select Any One
Hospital/Clinic
Pathology Lab
Bed Side
Screening in Camps
Self Use
Area of Application
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Select Any One
Cardiovascular
Dental
Dermatological & Plastic Surgery
ENT
Gastroenterology
General Hospital/Orthopaedic Instruments
Interventional Radiology
Nephrology and Renal Care
Neurological
Obstetrical and Gynecological
Oncology
Operation Theatre
Ophthalmology
Pain Management
Pediatrics and Neonatology
Personal Protective
Physical Support
Radiotherapy
Rehabilitation
Respiratory
Software
Non-Sterile, non-powered, hand-held or hand-manipulated and Invasive Surgical Instruments
Urology
IVD Analyzers
IVD Instruments
IVD Software
IVD-Specimen receptacle
In-Vitro Diagnostic Medical Devices
What type of Support(Handholding) you need?
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Select Any One
Testing Pre-clinical
Testing Clinical Investigation
Testing Clinical Performance Evaluation
Regulatory Strategy
Health Technology Assessment (HTA)
Uptake of new products/Public access
Financial Opportunities
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Select Any One
ICMR Extramural Research Grant-Small Grant
INTENT
Stage of your Innovation
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Under Concept Development
Concept Proved with Prototype
Bench Testing of Prototypes for Manufacturing Test License
Clinical Investigation/Performance/Clinical Performance Evaluation for Manufacturing License
Clinical Testing for National Program
Attach Report of Concept Proved with Prototype(In PDF Format only)
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4. Please specify your query
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3. MedTech Innovation Information
Name of the Drug/Vaccine/Biological
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Indication for use
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Area of application
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Select Any One
Cardiac anaesthesia
Cardiology
Child and Adolescent Psychiatry
Clinical Haematology
Clinical Immunology Rheumatology
Critical care Medicine
Endocrinology
Endocrine Surgery
Geriatric Mental Health
Gynecological Oncology
Hepato Pancreato Biliary Surgery
Hepatology
Infectious Disease
Interventional Radiology
Medical gastroenterology
Medical Genetic
Medical Oncology
Nephrology
Neurology
Neonatology
Neuro Surgery
Neuro anaesthesia
Organ transplant and critical care
Paediatric gasterology
Paediatrics and neonatal anaesthesia
Paediatric Surgery
Pediatric Hepatology
Plastic Surgery
Pulmonary Medicine
Reproductive Medicine and Surgery
Surgical Gastroenterology
Surgical Oncology
Urology Genitourinary surgery
Vascular Surgery
Any Other
Please mention Area of application (If not listed above)
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Target Population
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Paediatric
Adult
Elderly
Pregnant Women
Summary of the Drug/Vaccine/Biological
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Proposed phase of the study to be conducted
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Select Any One
Pre-clinical
Phase I
Phase II
Phase III
What kind of a support are you looking for?
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Technical support/Regulatory support
Financial support
Support for conduct of Trial
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