Forms and Templates


This page has been provided to assist Investigators and Study Teams to procure services within the University setting. Forms must be completed in their entirety and forwarded to the respective departments. Please contact ocr@emory.edu with any issues with opening a form.

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.

Clinical Trial Tools have been 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. All forms can be found on the Clinical Trials Audit and Compliance website. Clinical Trial Tools.

EML Grant Form

This form should be used ONLY when results should be EXCLUDED from posting to the subject’s Emory Healthcare medical record or they are non-Emory Healthcare patients or animals.

View EML Grant Form (RTF)

EML Non-Exempt Testing

This form should be used as a resource when determining labs that qualify as Non-Exempt Testing.

View EML Non-Exempt Testing (PDF)

EML Standard Description

This form provides a description of all EML Standard Labs

View EML Standard Description (PDF)

EML Checklist

This checklist provides instructions when submitting laboratory requests for research patients.

View EML Checklist_May 2021 (DOCX)

EML Standard Lab Orders

This form should be used as a resource when determining EML Standard Lab Orders and CPT codes.

View EML Standard Lab Orders (PDF)

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:

Study Participation

This form is used and must be submitted to OCR for subject reimbursement.

View Study Participation Form (PDF)

ACH Authorization

This form is used and must be submitted to OCR if the subject would like to get paid electronically.

View ACH Authorization Form

OCR Travel Reimbursement

This spreadsheet is to be used as a guide when submitting subject reimbursement information to OCR. DO NOT forget to send any receipts.

View OCR Travel Reimbursement Spreadsheet (Excel File)

ERMS Activation

(for Enrollment Notification, v7, 6.18.21) - this form 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.

View ERMS Activation Form (DOCX)

The Grady Medical Device Study Indemnification Acknowledgement Form is available for download on the "General Forms & Agreements" webpage on the Emory OSP website.

View EHC Request for Investigational Device Pricing (DOCX)

There are four 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

This form is used for ordering and scheduling imaging mandated by a research protocol for outpatients ONLY.

View Order for Research Study Form 

Emory University Radiology Checklist

This form is to be completed Pre-award for any study with protocol mandated Radiology procedures.

View Emory University Radiology Checklist

Order for Research Study in Emory Radiology that include Biopsies

This form is for any research study involving IMAGE-GUIDED BIOPSIES. If imaging alone is to be performed, please use the required Imaging Form.

View Order for Research Study in Emory That Include Biopsies Form

Request for Pre-Clinical (Phantom) Imaging

This form should be submitted to request Pre-Trial Imaging.

View Request for Pre-clinical Imaging Form

This form provides qualifying criteria for protocol submission to the Rapid Response Team as well as documents required to complete the submission process.

View Rapid Response Team Study Submission Form (DOCX)