Forms for the following:
Click on the name of the area to review content information. These documents are password protected. Access to secured documents requires an Emory University or Emory Healthcare login and password.
Note: You must review the forms below through Emory's Healthcare Intranet Virtual Desktop (VDT). Once you are logged into VDT, go to into Internet Explorer and the forms below can be view on CTBD's web page at http://www.ourehc.org/departments/tec-administration/patient-financial-services/interior_clinical%20trials.html.
- Charge Correction
- TEC Grant Payment
These tools were created in cooperation with the Institutional Review Board (IRB), Clinical Trials Audit and Compliance Office (CTAC) and the Emory's Office of Compliance (OC) for use by Investigators and their study teams involved in clinical trials. These are optional templates only. Please modify them to meet the needs of your department or trial.
The Emory Electronic Medical Record is the core of a patient centric environment and serves as the single source for information processing and access for a number of clinical processes and applications that integrate within the EeMR. For more information, visit web page Emory Electronic Medical Records.
If you have study monitors that will need to review subjects charts in EeMR, please contact the following for people for the appropriate forms for the locations indicated:
- EUH, EUMH, WW, and EUOSH - Audrey Faison, HIM Operations Manager, 404-712-1690, firstname.lastname@example.org
- Emory Johns Creek - Patricia Wilson, Secretary, Sr., EHI Medical Records, EJC & ESJH, 678-843-7306, email@example.com
- Emory St. Joseph - Patricia Wilson, Secretary, Sr., EHI Medical Records, EJC & ESJH, 678-843-7306, firstname.lastname@example.org
- The Emory Clinic - Brittany Tharp, Supervisor, 404-778-3808, email@example.com or Terri Vanpamelen, Director, Health Information Management, 404-778-4997, firstname.lastname@example.org
Note: The form below is used for Emory studies that are clinical trials with no Emory Healthcare billable procedures or services. These types of studies do not require OCR initial submission, however, the form must be submitted to OCR@Emory.edu before the study is activated in ERMS.
If you are conducting international research (whether as a student or as faculty), it is important to begin the IRB process as soon as possible. For more information, please refer to Emory's IRB website at http://irb.emory.edu/forms/international.html. Below are some helpful links.
- International Assessment Questionnaire
- Emory IRB Policies and Procedures: Chapter on "LOCAL RESEARCH CONTEXT; RESEARCH CONDUCTED AT NON-EMORY SITES"
- Study Site Permission, Permission to Use Data, and Cultural Context Guidance
- Cultural Context Template
- The federal Office for Human Research Protections International page, including a file compiling human research regulations from over 100 countries
Note: There are two research forms used for Emory studies that require Radiology services. Please review the research forms below on the Department of Radiology and Imaging Sciences webpage.
- Order for Research Study in Emory Radiology
- Emory University Radiology Checklist