Research Authorization Form .docVIP

550 First Ave. Building #VET 10 West NY, NY 10016 電話﹕212.263.4110 傳真﹕212.263.4147 INSTRUCTIONS FOR PREPARING THE RESEARCH AUTHORIZATION FORM: Please note that this shaded gray section is for instruction purposes only. Delete all of the text blocked in gray, when you are ready to prepare your Research Authorization Form. After you delete the instructions shaded in gray on the first and second page, the remaining pages of the document will shift up automatically. To enter the H# into the Header just click twice on the gray text. To exit the header, just click twice on the main text of the document. As explained more fully in NYU Investigator’s Guide, a covered entity may permit the use and disclosure of protected health information pursuant to a completed and signed Research Authorization form. This form will need to be carefully prepared by the Principal Investigator to ensure that the form covers all the uses and disclosure necessary for the research. This form is required by all researchers with IRB approved studies that require consent. If you will be consenting subjects after April 14, 2003, you will need to complete this form and use it as an attached addendum with your current approved IRB consent document. Subjects consented before April 14, 2003, will not have to be re-consented. The form is also available in Spanish. You will need to insert required name specific information for each study. The requested name specific information is shaded in gray. The document will be used with your existing approved IRB consent document and you will submit one copy to the IRB office to place on file. Upon the submission of future requests for, approval of amendment, final study closure and continuation each document will be reviewed for accuracy in content by the IRB or a designated member of the IRB. It is important to remember that each study participant will be required to sign and date the research authorization addendum. Remember to have the