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Research Forms

Category 2

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Forms for Retrospective Chart or Database Research

 

Retrospective review of PHI for research when it is impractical to obtain informed consent of the patients before reviewing the records and the disclosure of PHI is minimal risk to the subject

 

Research Administration Forms

 

1. MCH Application for Research (PDF format)

2. MCH IRB Submission Form

3. Protocol or description of the study

4. Data Collection Form or List of Database Fields

5. Curriculum Vitae (CV) for all investigators*

6. Human Subjects Protection Training Certificate, for all investigators*

 

*if not already on file

 

HIPAA Form

 

1. Form 2 - Waiver of Authorization

 

 

Submit to Office of Research Administration for Determination of Exemption or Expedited Review.

 

If you feel study is exempt, submit Claim of Exemption Form.