Carle Connect - Research Forms and Templates

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Carle Research Forms and Templates

Research Institute

Updated January 31, 2012

Listed below are all of the Carle IRB forms and templates used to submit a Research Study. Once they have been filled out, they will need to be uploaded to IRBNet. If this is your first time using IRBNet, you will need to register by creating a username and password on IRBNet. If you have any questions, please call the HSP Office Coordinator at (217) 326-4509.

Appendix A Carle Investigator Agreement

Appendix B Disclosure of Research Resources

Appendix C Children And Neonates As Research Subjects

Appendix D HUD Supplement To Research Application

Appendix H Human Biological Material

Appendix K Co-Investigators And Key Research Personnel

Application For Exempt Determination

Application For Full And Expedited Review Of Research

Carle Tissue Repository Appendix T

Carle Tissue Repository DUA

Carle Tissue Repository MTA

CIRB Additional Information Form

Conflict of Interest for Research

Continuing Review of Research

Guidelines for Writing a Research Study Protocol

HIPAA Accounting Disclosure Tracking Form

HIPAA Authorization to Use and Disclose Protected Health Information for Research Purposes

HIPAA Authorization Sensistive Information

HIPAA Decedent's Information Request

HIPAA De-Identification Certification

HIPAA Preparatory To Research, Data Review Request

HIPAA Privacy: Data Use Agreement

HUD Use Device Consent Form

Human Subject Research Determination

Humanitarian Use Device Submission Form

Informed Consent Template

IRB Authorization Agreement Initiation Form

IRB Guidelines for Humanitarian Use Devices (HUDs)

IRB Registration Form

Minor Assent Template

Modification Request Form

Project Closure Form

Prompt Reporting Form

Template - Brochure

Template - Flyer/Poster

Template - Letter/Form

Waiver of HIPAA Authorization Request

What Type of IRB Review Should I Request?

Carle Foundation Hospital, Carle Foundation Physician Services and Carle Physician Group contract with insurance providers separately and may or may not choose to participate in all of the same insurance plans. Patients are urged to check with their carriers as to whether services are covered for either or both organizations.

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