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Human Subjects Division (HSD)

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Document Details

download doc 1377
Download Document #1377
Last Updated 04/26/2013
Version 2.30
Filesize 2.24 MB
Audiences HSD Staff, IRB Member, Researcher
Doc Type Form
Use of HSD PDF Forms

HSD Forms are compatible with Adobe Reader, Version 8.1 and higher, though we recommend use of the most recent version. You may receive messages from Adobe to upgrade.

For Mac users: be sure to open the form in Adobe Reader or Acrobat.

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Use of Identifiable Biological Specimens/Data - PDF (formerly Medical Records Review)

Purpose

To gather the necessary information for the review of identifiable data and/or specimens of human subjects.  The form is limited to researchers who are not directly interacting with people, but who are reviewing identifiable private information about individuals and/or analyzing identifiable specimens.

Examples:

  • medical records
  • protected health information (PHI)
  • employment data
  • study records
  • pathology specimens
  • data and/or specimens from a repository

NOTE: This is the PDF version of this form

Related Documents

Change Notes

  • Related to Ver. 2.30, noted 04/26/2013 @ 11:32am
    Separated title and position fields in contact information section. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.20, noted 01/25/2013 @ 09:17am
    Updated FCOI language. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.10, noted 12/28/2012 @ 09:46am
    Updated to reflect change that we require only a notation of how frequently a sponsor may require training refreshers, rather than full documentation. Question 10.1. reformatted to reduce confusion. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.00, noted 11/30/2012 @ 09:42am
    Final version post beta-test. Previous versions will be accepted until 12/31/2012.
    - sherrye
  • Related to Ver. 1.10, noted 09/14/2012 @ 09:20am
    Corrected technical issues, made more clear that Waiver Request is needed with this form.
    - sherrye
  • Related to Ver. 1.00, noted 08/10/2012 @ 09:47am
    Document newly added.
    - sherrye