Protocol and Application Forms

Human Subjects Protocol Application

This packet includes: 1) Application for Initial Review, 2) A list of study documents needed, 3) PI Assurance Form, 4) Research Team Roster, 5) Conflict of Interest Form.

2021 Retrospective Review Protocol Template

This tool outlines sections needed in a protocol (that has purely descriptive objectives) for retrospective chart reviews. Note that every section may not be necessary, depending on your study.  This template should be used when these 3 criteria are met:

Your protocol reflects research involving materials (data, documents, records or specimens) that have been collected solely for non-research purposes (such as medical treatment or diagnosis); AND

Your protocol includes specific dates of data/information etc. that will be used; AND

All data is in existence at the time of IRB submission.

Case Report Determination Form

This packet includes information about a case report vs. a case series, HIPAA requirements, and publication guidance in addition to submission materials. On page 9, you will find a submission checklist outlining all components: CVs for all investigators and Research Study Team members, Proof of Good Clinical Practice (GCP) certification for all Research Study Team members, Case Report Determination/Assessment Form, Case Report Team Roster, PI Assurance forms, and Faculty Advisor’s Assurance Form.

Location Community Memorial Healthcare 147 North Brent Street 7th Floor Ventura, CA 93003 Phone 805 948 5683 E-mail library@cmhshealth.org Hours Staffed alternating Mondays 7AM - 3PM * 24 hour access with proxy reader for CMH community
search previous next tag category expand menu location phone mail time cart zoom edit close