PRISM — Patient Approach Card Generator

Patient Intake Form

Answer any fields you have available to generate a personalized Patient Approach Card. Only selecting at least one study is required. Study details and intake answers are sent to your local PRISM server, which uses AI (OpenRouter) to generate narrative sections.

Clinical Information

Trial(s) Being Considered *

Select one or more studies. For multi-trial comparison, select more than one. Manage studies in the Study Library →

Demographics & Medical History

Age

Language

Religion

Ethnicity

Race (check all that apply)

Black or African American White Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Other Prefer not to say

Marital Status

Employment Status

Primary Coverage

Legal Sex

Sex Assigned at Birth

Sexual Orientation

Health Problems

Current Medications

Prior violent encounter with physician/staff?

Translator Needed

Involved in other studies currently?

Social Drivers of Health

Alcohol Use

Tobacco Use

Substance Abuse

Financial Resource Strain

Depression

Food Insecurity

Housing Stability

Transportation Needs

Utilities

Interpersonal Safety

Research History

Prior Clinical Trial Experience

Additional Notes (Optional)

Anything else the coordinator should know?

Study Library

Manage your clinical trials here. Active and Enrolling studies appear in the patient intake form.

Study Name	Phase	Status	Therapeutic Area	Target N	Actions

Patient Intake Form

Study Library

Add Study

Delete Study

Import Studies

Patient Approach Card