VISN 5 MIRECC Required Forms

Research

For MIRECC Staff
Return to Conducting Research Guide
Go to Section One: New Protocol Approval
Go to Section Two: Setting Up the Research Study
Go to Section Three - The Ongoing Study
Names to Know

Required Forms

MIRECC

• Evaluation to Sign Consent Form
  
  
• MIRECC Readiness and Signature Form
  
  
• Sample CPRS Assessment Note
  
  
• Sample CPRS Enrollment Note
  
  
  

VA Research & Development

• Attestation for the Use of Devices, Equipment & Procedures in the Conduct of a Research Study
  
  
• Clinical Research Projects on Human Subjects Form
  
  
• Clinical Trials Data Sheet
  
  
• Human Protocols Appendix C & D
  
  
• Investigational Drug Information Record (VA Form 10-9012)
  
  
• Outpatient Clinic Profile
  
  
• Pharmacy Cost Memo for Human Studies Subcommittee
  
  
• Pharmacy, Invasive Procedures and Equipment Form
  
  
• Pharmacy Reimbursement for Research Studies
  
  
• R&D Human Studies Checklist