PNF FORM NO.
9-A: EVIDENCE TABLE 1 (to be attached to both Proposal Form for proponent and Evaluation Form for FEC use)
Application for: _____________________________________________________________________ Serial No.: _______________________________
Medicine: Generic Name: _________________________________________________________________________________________________________
Brand Name:___________________________________________________________________________________________________________
EVIDENCE TABLE 1
RESULTS/OUTCOMES
NO TITLE/ AUTHOR STUDY PARTICIPANT INTERVENTION EVENTS GRADE OF REMARKS
TREATMENT DRUG CONTROL DRUG
YEAR/JOURNAL DESIGN DESCRIPTION
GROUP GROUP EVIDENCE
(including adverse No. of Total # of No. of Total # of
events) events * patients events * patients
*group means with standard deviations may be reported if the data are continuous
PNF FORM NO. 9-B: EVIDENCE TABLE 2: GRADE TABLE (to be attached to both Proposal Form for proponent and Evaluation Form for FEC use)
Application for: ___________________________________________________________________ Serial No.: ________________________________
Medicine: Generic Name: _________________________________
Brand Name: __________________________________
EVIDENCE TABLE 2: GRADE EVIDENCE PROFILE TABLE
QUALITY ASSESSMENT SUMMARY OF FINDINGS Importance
No. of patients Effect Over-all
Quality
No. of Other Relative Absolute
Studies Design Limitations Inconsistency Indirectness Imprecision consideration Intervention Control (95% CI)
s
Outcome:
Outcome:
Outcome:
Outcome:
Outcome:
***NOTE: PLEASE UTILIZE ANY OF THE EVIDENCE TABLE, WHICHEVER IS AVAILABLE. ***