Forms and Templates

Biomedical Consent, HIPAA Authorization, + More


Consent Templates

    1. Industry Sponsor, Cooperative Group, or External IRB
      The IRB accepts all industry sponsored consent forms with minimal change in formatting. Industry consent forms need to only be modified to include the addition of USC specific requirements, such as local contact information, cost/injury payment language and removal of HIPAA. To facilitate review, submit an electronic version of the industry consent form and the version containing all USC specific modifications with all industry sponsored iStar submissions.
    2. HSIRB Informed Consent Template
      Used when there is no consent form from an industry sponsor or cooperative group.
      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.
    3. Information Sheet for Exempt Studies
    4. Child Assent Template

GDPR Addendum

  • GDPR Adendum to Consent | for USC studies complying with GDPR. Learn more about the GDPR regulations governing data obtained from Europe/European Economic Area (EEA) or on behalf of organizations based in the EEA.

Drafting a Consent Form


Short Form Consent Templates

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HIPAA Research Authorization

The following can be found on the Office of Ethics and Compliance website:

HIPAA Privacy Rule: Forms and Other Resources

  • HIPAA Research Authorization Forms (English and translations)
  • Instructions for completing HIPAA Research Authorization
  • Data Use Agreement for receipt of a limited data set
  • Request form for Decedents Protected Health Information
  • Authorization to Use Protected Health Information for Education and Instruction
  • Request for Protected Health Information for Preparatory Research Activities – Certification

See also

IRB Application Forms

Protocol Template for an Investigator Initiated Study
NIH Budget Form
Experimental Subject’s Bill of Rights
IRB Authorization Agreement-Long Form
Research Consultant Non Engagement Agreement
Individual Investigator Agreement
Required Documents for Research with Other Sites
Research Advisory Panel of California
California requires proposed research projects involving certain opioid, stimulant, and hallucinogenic drugs classified as Schedule I and Schedule II controlled substances to be pre-reviewed and authorized by the Research Advisory Panel of California in the Attorney General’s Office.

Ancillary Committees

Clinical Trials Unit at USC
USC Institutional Biosafety Committee Forms
Radiation Safety Committee Application Forms

LAC+USC Healthcare Network Forms

Lab Utilization Worksheet

Investigator Initiated Studies (Drug or Device)

Sponsor Investigator Agreement