Forms and Guidelines for Researchers

OUR FORMS NO LONGER OPEN USING INTERNET EXPLORER - PLEASE USE GOOGLE CHROME

Please submit electronically via our electronic IRB system (https://eirb.providence.org). If you need assistance please contact us at institutional.review.board@providence.org

Application - 

Conflict of Interest -

Consent Forms - Use of the ICF template is required. It has received full board review/approval. 

Continuing Review -  

  • Continuing Review Request Form - Contact IRB 

Deviations/Violations - 

Emergency Use Guidelines - 

Exemption Determination - 

HIPAA Privacy Rule Information and Forms -  

The Health Insurance Portability and Accountability Act (HIPAA) requires researchers to obtain authorization from subjects to use and disclose their protected health information. Refer to the explanation memo and forms below for requirements.

  • Application for Waiver of HIPAA Authorization - Application HIPAA Waiver, Version 11-16  
  • Definition of Protected Health information (PHI) and the 18 Identifiers - See Policy and Procedures
  • HIPAA Authorization Addendum - Part of Informed Consent Template, see above for link

 Modification (Sponsor Waiver or Exceptions) - 

  • Modification (Amendment), Sponsor Waiver or Exceptions) SOP - See Policy and Procedures
  • Change in Study Personnel SOP - See Policy and Procedures 
  • Modification Request Form - Contact IRB
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