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Home : About Meriter : Clinical Research : Supplemental Forms for Researchers

Supplemental Forms for Researchers

Log on to Meriter IRB Online Application Site

IRB Application Coaching

One on one in person or over the phone. Use contact information below to make an appointment.

Meriter IRB Office
202 South Park Street
Madison, WI 53715

Liz Michaels, MS, CIP
IRB Coordinator
lmichaels@meriter.com
 
Office: (608) 417-6411
Fax: (608) 417-5675

Office Located on Meriter Hospital Campus
229 McConnell

Map & Directions to IRB Office

Download and complete the following forms to submit with your online application.

Consent Document

Customize this template by adding or deleting text as it applies to your research. Please do not delete text that is mandatory.

HIPAA Research Forms


Research Posted on Meriter.com

Complete a research listing form if anyone on the research team interacts with subjects. This form is not required for record review or biospecimen research.
  

Record Review Research Forms

The Patient Records Endorsement form is mandatory for Record Review Research. 

The Electronic Data Security Endorsement form is mandatory for electronic record review research where identified date is being stored or transferred.


UW Deferral Forms

Download, print and have the Principal Investigator sign off on theses completed forms. Scan the forms into your computer and attach them to your online deferral submission.