UnityPoint Health - Meriter Supplemental Research

ER - Madison

4 min Average

Supplemental Forms for Researchers

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

Collaborator Endorsement Letter

Collaboration Endorsement Letter Template: 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.

Consent Document

Consent Template: Customize 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

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

Record Review Research Forms