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Templates and Forms

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Biomedical

See also: Suggested consent form language

Consent Forms

File Version Date
Consent and HIPAA Authorization Form
Replaces Version Dated: 12/4/13
5/16/14
Consent Form (No HIPAA)
Replaces Version Dated: 12/4/13
5/16/14
Emergency Use Consent Form
Replaces Version Dated: 7/13/03
4/5/12
Humanitarian Use Device Clinical Consent
Replaces Version Dated: 4/5/12
9/13/12
Online Consent
Replaces Version Dated: 9/13/12
4/13/13
Verbal Consent
Replaces Version Dated: 9/13/12
4/13/13

Parental Consent and Assent Forms

File Version Date
Parental Consent and HIPAA Authorization Form
Replaces Version Dated: 12/4/13
5/16/14
Parental Consent Form (No HIPAA)
Replaces Version Dated: 9/13/12
5/16/14
Assent Form
Replaces Version Dated: 9/13/12
4/13/13
Assent Script
Replaces Version Dated: 9/13/12
4/13/13

Protocol Templates

File Version Date
Biomedical Protocol Template - Interventional
Replaces "Key Elements of a Biomedical Protocol"
4/5/12
Biomedical Protocol Template - Non-Interventional
Replaces "Key Elements of a Biomedical Protocol"
4/5/12
Chart Review Protocol
Replaces Version Dated: 2/3/11
4/5/12
Data Coordinating Center Protocol 4/5/12
Lead Coordinating Center Protocol 4/5/12

Social-Behavioral

See also: Suggested consent form language

Consent Forms

File Version Date
Consent Form
Replaces Version Dated: 9/13/12
4/13/13
Consent Form and HIPAA Authorization Form
Replaces Version Dated: 4/13/13
7/30/13
Online Consent
Replaces Version Dated: 9/13/12
4/13/13
Verbal Consent
Replaces Version Dated: 9/13/12
4/13/13

Parental Consent and Assent Forms

File Version Date
Parental Consent Form (No HIPAA)
Replaces Version Dated: 4/13/13
5/10/13
Assent Form
Replaces Version Dated: 9/13/12
4/13/13
Assent Script
Replaces Version Dated: 9/13/12
4/13/13

Protocol Templates

File Version Date
Social Behavioral Protocol Template
Replaces Version Dated: 4/5/12
4/13/13
Data Coordinating Center Protocol 4/5/12
Lead Coordinating Center Protocol 4/5/12

Short-Form Consent

The following are posted with permission from the University of Minnesota. See OHRP's Guidance on obtaining and documenting informed consent of subjects who do not speak English.

See also: Consent Translation and Short Form Guidance

Contact :
Chicago
Arthur Rubloff Building, 7th Floor
750 N. Lake Shore Dr.
Phone: (312) 503-9338
Fax: (312) 503-0555
irb@northwestern.edu
Evanston
Chambers Hall, 2nd Floor
600 Foster St.
Phone: (847) 467-1723
irb@northwestern.edu

 

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