Supplemental Forms for Researchers

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

Record Review Research Forms

Patient Records Endorsement Form: mandatory for record review research.
Data Research Summary Form: mandatory for most record review research.

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.

Consent Template

Consent Checklist

Formatting to Accommodate IRB Approval Stamp

HIPAA Authorization Form

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

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