Templates and Forms
Protocol TemplatesThe Spectrum Health IRB has provided the following templates for use by the research community. A protocol is required to be included in all IRB submissions.
Consent Templates and HIPAA Authorization TemplatesInformed consent is an active process through which investigators provide research volunteers with the information that they need to make informed decision to join a study.
The Spectrum Health Institutional Review Board has provided the following templates for the research community. The templates include instructions on how to use the template, what is needed, or required, in each section of the form with additional template language for special topics.
When writing consent documents, it is advisable to start with the Spectrum Health Institutional Review Board documents and add in information from another sponsor-provided template. Avoid using jargon and advanced technical or scientific terms in the consent document. Research volunteers from all backgrounds need to be able to read and understand the document.
The Spectrum Health Institutional Review Board will review consent forms to ensure that the forms are well-written, include all the required regulatory elements, and that the information is presented in order to facilitate understanding.
- Biomedical GTMR - for clinical trials and studies that are greater than minimal risk (GTMR)
- Minimal Risk - for interactions and interventions that are minimal risk (e.g., sample collection, surveys, social-behavioral studies, etc.)
- Assent Form - for enrolling adolescent participants
- Information Sheet - for use when the IRB has waived the requirement to obtain a signature for consent for a verbal or electronic survey
- Stand-alone HIPAA Authorization Form - for use in Single IRB studies or when the IRB requires a separate HIPAA form
- HIPAA Authorization for Reimbursement - for use when participants will receive compensation or payment
Non-Research Use Consent Templates
- Treatment Use - for use when treating a patient with an investigational drug, biologic, or device (not a research study or clinical investigation)
Short Form TemplatesThe following short forms are provided to the research community to enroll participants who cannot use the standard form, have limited English proficiency or are non-English speakers. If an investigator plans to include non-English speakers in their targeted population, translation of the standard form is recommended and may be required by the Spectrum Health Institutional Review Board.
- Short Form - English
- Short Form - Spanish
- Short Form - Bosnian
- Short Form - Vietnamese
- Short Form - Italian
- Short Form - French
- Short Form - Korean
- Short Form - Arabic
Forms to Request Ancillary Services
- Letter of Collaborating Department-Division (PDF)
- Letter of Ancillary Services Support (PDF)
- Request for Cardiovascular Imaging Services (DOC)
- Request for Investigational Drug Services
- Request for Laboratory (DOC)
- Request for Nursing Services (DOC)
- Request for Pulmonary-Respiratory Therapy Services (DOC)
- Request for Radiology Services (DOC)
- Request for Surgical Services (DOC)