IRB Forms

	Addendum for Mutli-site Studies Where Rex Hospital is the Lead Coordinating Center
	Application for Initial Protocol Review
	CIRB Notification Form
	Collection of SSN for Payments to Research Subjects
	Collection of SSN for Use as an Identifier in a Research Study
	Confidentiality Statement
	Continuing Review Form
	Contractor Compliance with the NC Identity Theft Protection Act
	Facilitated CIRB Continuing Review
	HIPAA Authorization for Research Use and Disclosure of Health Information for Research Purposes
	Informed Consent Checklist

	IRB Notification Form
	IRB Tip Sheet
	Laboratory/Pathology Department Clinical Research Support Fact Sheet
	Protocol Violation Reporting Form
	Reliance Agreement Tip Sheet
	Report of Emergency Use of Test Article to the IRB
	Required Education in Human Subjects Protections Documentation of Alternate Training
	Research Protocol Deviation Log
	Sample Short Form Written Consent Document for Subjects Who do Not Speak English
	Unanticipated Serious Adverse Event Reporting Form
	Waiver of Consent & HIPAA Authorization

REX - UNC Health Care