AARHPP

Health Sciences Forms Templates

Templates and forms on this menu have been designed to include elements required for biomedical studies, clinical trials, and other studies that include the use of protected health information (PHI).

Consent Documents, Consent Cover Letters, Consent Information Sheets, Consent Scripts, etc.
FORMS Tracked Changes Version Date
Consent and Authorization Document Template Tracked Changes 02.08.2012
Consent and Authorization Document (for Minimal Risk Research) Template Tracked Changes 02.08.2012
Consent and Authorization Cover Letter Document Template Tracked Changes 11.20.2011
Consent Cover Letter Document Template Tracked Changes 11.20.2011
Pregnancy Follow-Up Consent and Release of Information Authorization Document Template   02.14.2012
CCTS Consent Executive Summary Template (CCTS)   04.02.2009
Tissue/Specimen Banking Consent Language Tracked Changes 01.03.2012
Witness Signature Page Tracked Changes 11.20.2011
Utah Population Database (UPDB) Consent and Authorization Requirements   02.01.2011
Humanitarian Use Device (HUD) Consent and Authorization Document Template Tracked Changes 02.08.2012
Parental Permission Documents
FORMS Tracked Changes Version Date
Parental Permission and Authorization Document Template Tracked Changes 02.08.2012
Parental Permission and Authorization Document (for Minimal Risk Research) Template Tracked Changes 02.08.2012
Humanitarian Use Device (HUD) Parental Permission and Authorization Document Template Tracked Changes 02.08.2012
Assent Documents
FORMS Tracked Changes Version Date
Assent Document Template Tracked Changes 02.08.2012
Humanitarian Use Device (HUD) Assent Document Template Tracked Changes 01.03.2012
VA Consent Documents
FORMS Tracked Changes Version Date
VA Certification of Informed Consent   01.21.2011
VA Authorization Document Template Tracked Changes 01.03.2012
VA Consent Document Template Tracked Changes 02.08.2012
VA Consent and Authorization Document Template Tracked Changes 02.08.2012
VA Checklist for Reviewing Privacy, Confidentiality, and Information Security in Research   12.01.2010
Humanitarian Use Device (HUD) VA Consent and Authorization Document Template Tracked Changes 02.08.2012
Translated Consent Documents
FORMS Tracked Changes Version Date
Short Form Consent Document Template (Arabic)   12.20.2010
Short Form Consent Document Template (Bosnian)   12.20.2010
Short Form Consent Document Template (Chinese-Cantonese)   12.20.2010
Short Form Consent Document Template (English) Tracked Changes 12.20.2010
Short Form Consent Document Template (French)   03.23.2012
Short Form Consent Document Template (Nepali)   12.20.2010
Short Form Consent Document Template (Russian)   11.14.2008
Short Form Consent Document Template (Spanish) Tracked Changes 05.20.2011
Short Form Consent Document Template (Tongan)   12.20.2010
Short Form Parental Permission Document (English)   12.20.2010
Short Form Parental Permission Document (Spanish) Tracked Changes 12.20.2011
Short Form Translation Certificate (Arabic)   06.20.2011
Short Form Translation Certificate (Bosnian)   06.20.2011
Short Form Translation Certificate (Chinese-Cantonese)   10.06.2009
Short Form Translation Certificate (French)   03.29.2012
Short Form Translation Certificate (Nepali)   06.20.2011
Short Form Translation Certificate (Russian)   11.14.2008
Short Form Translation Certificate (Spanish)   02.13.2008
Short Form Translation Certificate (Tongan)   06.20.2011
Spanish Translations of IRB Consent Template Boilerplate Tracked Changes 03.08.2011
Translation Certification Letter Template   11.22.2011
Full Protocol Documents
FORMS Tracked Changes Version Date
Sponsor-Investigator Policies and Procedures Template - Devices Tracked Changes 01.03.2012
Sponsor-Investigator Policies and Procedures Template - Drugs and Biologics Tracked Changes 01.03.2012
Recruitment Materials, Advertisements, etc.
FORMS Tracked Changes Version Date
Recruitment Letter Template   05.14.2010
External Sites and Agreements Documents
FORMS Tracked Changes Version Date
Data Transfer Agreement (DTA) Template   09.15.2008
Data Use Agreement (DUA) Template - UUHSC   09.15.2008
Data Use Agreement (DUA) Template - IHC   06.09.2008
HIPAA Assurance Letter Template   11.20.2011
Information for Accounting of Disclosures Template   11.20.2011
IRB Authorization Agreement (IAA) Template   11.20.2011
Material Transfer Agreement (MTA) Template   N/A
Research Compliance Agreement (RCA) - Individual Investigator   11.20.2011
Research Compliance Agreement (RCA) - Institution   11.20.2011
Other Documents
FORMS Tracked Changes Version Date
Certification for Emergency Use of a Test Article without Informed Consent   01.03.2012
Case Report Using Existing Data Author Worksheet Tracked Version 11.13.2010
Expired Study Continuation Request Form   01.03.2012
Payment Process Exception Request Form   01.03.2012
Quarterly Report Template Tracked Version 01.03.2012
Research Preparation Form Tracked Version 01.03.2012
Research Using Decedents' Information Form Tracked Version 01.03.2012
Simple Referral Template   05.14.2010
Tissue Bank Management Plan Template   01.18.2012
VA Criteria vs. Affiliate Form   02.21.2012
Other Stamped Documents
FORMS Tracked Changes Version Date
Data/Information Request Form (UUHSC EDW) Tracked Changes 01.03.2012
"What Are These Documents For?" Guides
FORMS Tracked Changes Version Date
Consent Cover Letter Instructions for Use   04.16.2010
Short Form Consent Instructions for Use, etc.   07.20.2009