Supplemental Forms for Researchers

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

Record Review Research Forms

Data Research Summary Form: mandatory for most record review research.
Permission to use Meriter's PACs for Research form.
File Sharing Policy: Electronic file transfer must comply with the tools listed.

Interventional Research Forms

Collaboration Endorsement Letter Template
Use this to document how UnityPoint Health – Meriter staff will help facilitate your research on our premises. The letter should be signed by a department or work area manager, director or other authority.

Permission to Contact Form (HIPAA Compliant)

Consent Template

Consent Checklist

Formatting to Accommodate IRB Approval Stamp

HIPAA Authorization Form

Meriter Site Supplement

Website Listing Form: Complete this form if your research has a consent document. This form is not required for record review or biospecimen research.

Emergency Department

Supplemental Forms for Researchers

Record Review Research Forms

Interventional Research Forms

A Proud Partner of UW Health