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. ***