Institutional Review Board

COVID-19 Witness Signature & Attestation Page

VA Documents and Forms

Recruitment Letter Template

Full Protocol Documents

Data Use Agreement (DUA) Template – IHC

Agreement for Public Ethnographic Studies

COVID-19 Person Obtaining Consent Attestation Page

Research Consent Process Worksheet – Obtaining Signed Consent During the COVID-19 Pandemic

Blank Watermark Document

CTSI Consent Executive Summary Template (CTSI Document)

Debriefing Document Template

Pregnancy Follow-Up Consent and Release of Information Authorization Template

Translation Certification Letter Template

Signature Block Samples

LAR Signature Page

Witness Signature Page

Utah Population Database (UPDB) Consent and Authorization Requirements

Humanitarian Use Device (HUD) Informed Consent Checklist

Expanded Access Informed Consent Checklist

Emergency Use Consent and Authorization Document Template

VA Emergency Use Consent Document Template

VA Humanitarian Use Device (HUD) Consent and Authorization Document Template

VA IRB Documentation of Waiver of HIPAA Authorization for Research

VA Revocation of Authorization for Use & Release of Health Information Form 10-10116

Simple Referral Template

Data Use Agreement (DUA) Template – UUHSC

Please contact Technology Licensing Office

Material Transfer Agreement (MTA) Template

Please contact Technology Licensing Office

Certification for Emergency Use of a Test Article without Informed Consent

Case Report Using Existing Data Author Worksheet

• The University of Utah Health patient authorization form for use of PHI in publications is available on Pulse (University employee access only). 

Data / Biospecimen Repository Management Plan Template

Department of Defense (DoD) Supplement

Exclusion of Research Data in EMR Request Form
Available on Pulse (University employee access only) University of Utah Health Form Only; This is not a requirement of all studies that use the University of Utah IRB.

Payment Process Exception Request

Privacy Protection Verification for Research Conducted in Schools

Exemption Umbrella Annual Report Template

Research Preparation Form

Research Using Decedents’ Information Form