Research

 

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For Questions about submitting paperwork to VALBHS IRB, please contact the IRB assistance at 562.826.8000 extension 3301.

Expedited Continuing Review

1. Form 10-1223 - Report of Subcommittee on Human Studies

2. R&D Committee Pre-Review of Continuing Project

3. Report of Review Action Form

4. Reviewer Worksheet ICF-HIPAA Authorization

ICF HIPAA Form

1. Consent for Use of Picture and/or Voice (VAF10-3203)

2. HIPAA Authorization Form  (VER.01Mar2013)

3. HIPAA/ICF Waiver 

4. Informed Consent Guidance and Template(VAF10-1086) (VER.01Mar2013)

5. Physician Referral Authorization HIPAA Form

6. Physician Referral Revocation HIPAA Form

7. Revocation HIPAA Form

8. Request for Waiver of Signed Informed Consent Form

9. Waiver for recruitment and Screening

Pre-review Paperwork

1. IRB Reviewer Worksheet ICF-HIPAA Authorization

2. IRB Reviewer Worksheet-Criteria for Approval

3. Medical Device Risk Determination Form

4. Pre Reviewer Worksheets

5. Reviewer Worksheet for Continuing Review

6. Reviewer Worksheet New Projects

Additional Forms

1. Application for IRB Review (VER.01Nov2012)

2. Application for IRB Continuing Review (VER.01Nov2012)

3. Application for IRB Review Supplement  (VER.01Nov2012)

4. Application for IBC Review

5. Clinic Request Form Version 12

6. Common Orderable Lab Test with CTP Code FY 2010 Information Sheet  - Contact SCIRE Office for the complete list of Orderable Lab Test

7. Data Use and Security Plan

8. Deviation Unanticipated Problem Reporting Form  (VER.01Nov2012)

9. Device Plan

10. Disclosure of Relationships and Financial Interests Form

11. Exempt Eligibility Determination Form (VER.2012.10)

12. Financial Disclosure for Principal Investigators

13. For Profit Tissue Baking Application

14. FDA Form 1572-Statement of Investigator

15. Guidelines for Narrative Description of Proposed Research

16. Impact Estimation Worksheet (IEW) Diagnostic & Molecular Medicine (VER.MAR.2013)

17. Impact Estimation Worksheet (IEW) Pharmacy

18. Investigational Drug Information Record (VAF10-9012)

19. Inclusion Exclusion Criteria Checklist

20. Investigational Drug Information Record

21. Local Serious or Unexpected Adverse Event Notification Form (VER.01Mar2013)

22. Memo Template

23. Modification of an Approved Project

24. Non-Local Adverse Event Notification Form (VER.01Mar2013)

25. Non Profit Tissue Banking Application

26. Non-Veteran/Humanitarian Enrollment Form (VER.2010.03)

27. Notice of Privacy Practices (VER.2010.08)

28. Orderable Lab Test with CTP Codes FY2010

29. Off Site Projects (VER.24July2012)

30. Project Data Sheet and Abstract VAF10-1436

31. Project Submission Checklist (VER.01Nov2012)

32. Prospectus of Research Study Form  (VER.2011.06)

33. Scope of Practice

34. Safety Survey Local (VER.2008.08)

35. Statement of Investigator (FDA From 1572)

36. Study Monitor Form