Health Sciences Forms and Templates


Informed Consent

 

HSIRB Consent Template-
Industry Sponsor, Cooperative Group, or External IRB
HSIRB Informed Consent Template
This template should be used when a consent form has been provided by an industry sponsor or cooperative group. This document can also be used when relying on an external (non-USC) IRB (except for the National Cancer Institute Central IRB).

This template provides sections in which to insert the consent language provided by the sponsor. It does not include examples and is a shorter template.

This template should be used when there is no consent form from an industry sponsor or cooperative group. This template includes the essential elements of consent, instructions for use, the California Subjects Bill of Rights, conflict of interest requirements, considerations for long term specimen use and other institutional requirements.

Informed Consent Resources

Information Sheet Templates

Short Form Consent Templates

(including Experimental Subject’s Bill of Rights)
To access only Short Form Consent templates, click here.

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HIPAA Research Authorization

HIPAA Authorization
for research purposes
(form for disclosure of
protected health information)
English Word PDF
Spanish Word PDF
Korean Word PDF
Armenian Word PDF
Traditional Chinese Word PDF
Requests form to access protected health information (held by USC) to prepare a research protocol or perform other activities preparatory to research
Authorization for use of PHI for educational purposes
Data Use Agreement for receipt of a limited data set
Request form for Decedents Protected Health Information

 


IRB Application Forms

Example/Model Study Applications for Health Sciences IRB

Ancillary Committees

LAC+USC Healthcare Network Forms

Investigator Initiated
(IDE /IND holder)

CHLA Forms