Forms & Templates
Research Consent Process Worksheet – Obtaining Signed Consent During the COVID-19 Pandemic
Version Date: March 30, 2020
Pregnancy Follow-Up Consent and Release of Information Authorization Template
Version Date: April 21, 2021
Utah Population Database (UPDB) Consent and Authorization Requirements
Version Date: February 1, 2011
VA Humanitarian Use Device (HUD) Consent and Authorization Document Template
Version Date: August 17, 2015
VA IRB Documentation of Waiver of HIPAA Authorization for Research
Version Date: July 1, 2011
VA Revocation of Authorization for Use & Release of Health Information Form 10-10116
Version Date: September 1, 2015
Data Use Agreement (DUA) Template – UUHSC
Version Date: October 22, 2024
Please contact Technology Licensing Office
Certification for Emergency Use of a Test Article without Informed Consent
Version Date: January 3, 2012
Case Report Using Existing Data Author Worksheet
- The University of Utah Health patient authorization form for use of PHI in publications is available on Pulse (University employee access only).
Version Date: September 1, 2015
Exclusion of Research Data in EMR Request Form
Available on Pulse (University employee access only) University of Utah Health Form Only; This is not a requirement of all studies that use the University of Utah IRB.
Version Date: October 22, 2024
Privacy Protection Verification for Research Conducted in Schools
Version Date: August 15, 2017