Get Uahs Research Intake Application Retrospective Chart Review/crdw Request Form 2020

Filling out the UAHS Research Intake Application Retrospective Chart Review/CRDW Request Form is a crucial step for researchers seeking to conduct retrospective chart reviews. This guide provides you with detailed, step-by-step instructions to help you accurately complete the form online.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. In the 'Study Contact' section, provide your last name, first name, phone number, and UA email address to ensure communication regarding your study.
3. Complete the 'Study Overview' section by entering your study protocol number or nickname, the principal investigator's name, their UA email address, the college, and the clinical department, making your selections from the dropdown menus.
4. In the 'Medical Center Information' section, indicate if your study will review medical records, data, and/or specimens by selecting 'Yes' or 'No'. If applicable, choose the medical center from the list provided.
5. Answer whether any study staff not affiliated with Banner UMG or Dignity St. Joseph will have access to Protected Health Information (PHI), and if data from Cerner is required, complete and upload the CRDW Request Form as instructed.
6. In the 'Study Agreement/Contract' section, select whether the sponsor/funder provided a template agreement and state what type of UArizona agreement may be needed.
7. Provide the study sponsor or organization name, and fill in contact information for the contract negotiator and budget negotiator, if applicable.
8. Example any comments, special instructions, or notes in the designated section that may be relevant to your submission.
9. Attach all required documents listed at the end of the form, ensuring each document title, description, and status (required or optional) is accurately indicated.
10. Upon completing the form, save your changes, and you may opt to download, print, or share the completed form as needed.

Complete your UAHS Research Intake Application Retrospective Chart Review/CRDW Request Form online today to facilitate your research process.