Forms and Templates

New Study Initial Review Submission Documents

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

Data Requests for Research

• All requests for research data from UMC require that a Service Request be submitted through:  https://itservices.umcsn.com/
• All requests must include the UMC IRB approval letter and a completed Report/Data Request Form

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