Supplemental Forms for Researchers

Download and complete the following forms to submit with your online application.

Collaborator Endorsement Letter

This template is required when an investigator relies on UnityPoint Health – Meriter staff to aid their research in some way. The letter spells out in what ways the collaborating person/department will help the researcher. The letter should be signed by a department or work area manager, director or other authority.

Examples of research collaboration carried out by non-research staff:

  • Handing out recruitment materials.
  • Passing information such as consent to contact forms from prospective subjects to the investigator.
  • Keeping recruitment brochures and flyers available in waiting or examining areas.
  • De-identifying and/or coding a bio-specimen and temporarily storing it until research staff can pick it up.

Collaboration Endorsement Letter Template

Consent Document

Customize this template by adding or deleting text as it applies to your research. Please do not delete text that is mandatory.

HIPAA Research Forms


Research Posted on UnityPoint.org

Complete a research listing form if anyone on the research team interacts with subjects. This form is not required for record review or biospecimen research.

Record Review Research Forms

The Patient Records Endorsement form is mandatory for Record Review Research.

The Electronic Data Security Endorsement form is mandatory for electronic record review research where identified data is being stored or transferred.