Forms and Templates

Parking & Campus Map Travel to UMC COVID-19 Resources

Pay Your Bill

• Human Research Protection
• Institutional Review Board

  • Submit a New Application
  • Forms and Templates
  • Policies and Guidance
  • Training and Education
  • Case Report/Series
• Clinical Trials Office

New Study Initial Review Submission Documents

• Clinical Trials Office Research Application (Required for submissions that have billable items and/or services)

Templates

Protocol

• Biomedical Protocol Template
• Social Behavioral Protocol Template
• Chart Review Protocol Template
• Retrospective Chart Review Application Sample

Informed Consent Document

• INFORMED CONSENT AND AUTHORIZATION TO PARTICIPATE IN RESEARCH (Adult)
• Revocation Letter Template

Assent Document

• Assent Template (Children)
  

HIPAA Document

• PHI Identifiers

     Data Collection Tools

• Data Collection Tool / Form
• Coded Identifier List

Reportable Events

• UMC IRB Guidance Investigator Reporting Obligations – version 1, dated 06/2015
• UMC Sample Reportable Event Summary – version 1, dated 06/2015
• Reportable Events Assessment Tool dated 06/18/2015

Conflict of Interest

• Conflict of Interest & Disclosure

Permanent Closure of Research Protocol

• Final Report
• Final Report for Exemption/PHI Request

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