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Office of Compliance

Human Subjects Committee

New: Consultation and Pre-Review Services

Forms

 

Word
PDF
 
Revised
      INITIAL SUBMISSION FORMS    
 
 
  Required Paperwork for Submission to the KUMC Human Subjects Committee  
05-02-2007
Word Document
    Application for Full Committee Review of Human Subject Research Instructions PDF
07-19-2007
Word
    Application for Expedited Review of Human Subject Research
5-15-2008
Word
    Application for Review of Retrospective Human Subject Research  
5-12-2008
Word
    Application for Exempt Review of Human Subject Research Instructions PDF
5-15-2008
Word
    Scientific Merit Review Template Instructions PDF  
Word
    Application Addendum for Cancer and Cancer-Related Studies    
Word
    Nursing Impact Form  
10-26-2007
Word Doc
    Supplemental Application for IND and IDE sponsors  
06-15-2007
Word Doc
    Application for Waiver of HIPAA Privacy Authorization Studies Using PHI    
Word
    Request to Rely on the Lawrence HSC  
   
  CHANGES AND UPDATES TO APPROVED STUDIES  
    Request for Amendments:  
    >> Recruitment/Retention Materials  
    >> Change in Study Personnel or Study Sites  
   

>> Investigator's Drug or Device Brochure

 
   

>> Protocol and Other Amendments

 
       
    PROBLEM REPORTS  
   
Problem Report A - Internal Adverse Drug Event
 
   
Problem Report B - External Adverse Drug Event
 
   
Problem Report C - Unanticipated Adverse Device Event
 
   
Problem Report D - Report of Non-Compliance 
 
   
Problem Report E - Study-Related Complaint
 
   
Problem Report F - Monitoring/Audit Report
 
   
Problem Report G - Incarceration of a Study Participant
 
   
Problem Report H - Breach of Confidentiality/Loss of Data
 
   
Problem Report I - Other Problems
 
   
Report of New Information
 
     
    CONTINUING REVIEW AND CLOSURES
Word Doc
  Continuing Review Form (formerly called Summary Progress Report)
6-15-2007
Word Doc
  Continuing Review Supplement for Cancer and Cancer-Related Studies  
Word
  Protocol Summary  
Word
  Closure Request Instructions PDF
04-05-2006
       
    CONSENT FORM TEMPLATES  
Word
  Consent Form Template 1
6-23-2008
   

This template is appropriate for studies involving FDA-regulated products. It is also recommended for any other study in which external parties (such as sponsors or collaborators) will receive study data that has not been fully de-identified according to HIPAA standards. *

Word
  Q & A Consent Template for Clinical Trials (New)
6-23-2008
    This consent template, appropriate for FDA-regulated studies, is written in a Question and Answer format.
 
  Consent Form Template 2 
6-23-2008
   

This template should be used for internal studies and for other projects where all data released to external parties has been de-identified according to HIPAA standards. *

Word
  Consent Template for Surrogate Decision-Makers
3/26/2008
   

This template is appropriate for persons who are consenting to research on behalf of another adult who does not have decisional capacity.

Word Doc
  Consent Template for Humanitarian Use Devices
3-10-2008
    Approval for a humanitarian use device (HUD) involves special considerations from FDA and the HSC. Please contact the HSC Office for more information when proposing the use of an HUD.
 
Word Doc
  Consent Template for Optional Genetic Research
4/21/2008
       

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