PC-CTU Patient and Public Involvement (PPI) Network Recruitment 基層醫療臨床試驗小組公眾及病人參與成員招募

1. Name / 姓名
2. Year of Birth / 出生年份
3. Mobile Number / 電話
4. Email Address / 電子郵箱
5. Highest level of education / 最高學歷
6. Occupation / 職業

Student, Homemaker, Secondary School Teacher, Accountant, Architect, Administrative Staff, Clerk, Lawyer, Retired Person, Banking Professional, Self-employed, etc.
可填：學生、家庭主婦、中學教師、會計師、建築師、行政人員、文員、律師、退休人員、銀行業從業人員、自由職業等
7. Do you currently work, or have you previously worked, in healthcare, public health, or primary care-related fields? 您現時或曾於醫療保健、公共衞生或基層醫療相關領域工作嗎？

7. Do you currently work, or have you previously worked, in healthcare, public health, or primary care-related fields? 您現時或曾於醫療保健、公共衞生或基層醫療相關領域工作嗎？ No / 否 Yes / 是 If yes, please specify: / 如果是，請註明：
8. Have you received any education, training, or experience in health research, clinical trials, or patient and public involvement (PPI)? 您是否曾接受與健康研究、臨床試驗或病人及公眾參與（PPI）有關的教育、培訓或體驗？

8. Have you received any education, training, or experience in health research, clinical trials, or patient and public involvement (PPI)? 您是否曾接受與健康研究、臨床試驗或病人及公眾參與（PPI）有關的教育、培訓或體驗？ No / 無 Yes / 是 If yes, please specify: / 如果是，請註明：
9. Do you have lived experience with a chronic disease or long-term health condition? 您是否有慢性疾病或長期健康狀況的親身經驗?

9. Do you have lived experience with a chronic disease or long-term health condition? 您是否有慢性疾病或長期健康狀況的親身經驗? No / 否 Yes / 是 If yes, please specify: / 如果是，請註明：
10. Available time for PPI activities（Select all that apply）：
可參與病人及公眾參與（PPI）活動的時間（可多選）：

10. Available time for PPI activities（Select all that apply）：可參與病人及公眾參與（PPI）活動的時間（可多選）： Weekday daytime / 平日日間 Weekday evening / 平日晚間 Weekend / 週末 Flexible / 時間彈性
I agree to be contacted by the Primary Care Clinical Trial Unit (PC-CTU) regarding future PPI activities, consultation opportunities, and research-related events via telephone (2609 5050) and/or WhatsApp (5288 8958). 本人同意基層醫療臨床試驗小組（PC-CTU）透過電話（2609 5050）及／或 WhatsApp（5288 8958）與本人聯絡，以通知未來PPI活動、研究諮詢機會及相關研究活動。

I agree to be contacted by the Primary Care Clinical Trial Unit (PC-CTU) regarding future PPI activities, consultation opportunities, and research-related events via telephone (2609 5050) and/or WhatsApp (5288 8958). 本人同意基層醫療臨床試驗小組（PC-CTU）透過電話（2609 5050）及／或 WhatsApp（5288 8958）與本人聯絡，以通知未來PPI活動、研究諮詢機會及相關研究活動。 Yes / 同意
Disclaimer The personal data collected will be used by CUHK-SPHPC Clinical Trial Unit and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.