Transnational Access Form – Clinical access

    Fill in the following form to request beam time for clinical research

    Applicant's data

    Period (approximately 5 working days)

    Clinical facility preference CNAOHITMarburgMedAustron

    Profession (number)

    Report of the applicant physician (to be filled only for clinical case submission)

    1. Patient information: disease diagnosis, disease stage, non-cancer history, detailed cancer history, ongoing therapies, drugs, active problems and any other information useful for the evaluation
    2. Information on the reasons and objectives of the request to use the facility
    3. File upload of (each in backward chronological order, clearly dated files):
    • physician’s letters, including tumor board (if available) and operation reports (if surgery was performed)
    • histology
    • imaging results (MRT, CT, PET-CT)
    • prior irradiation plans