VA Related Forms

• PI Data Checklist
• Request to Review Proposal
• VA FORM 10-5345 Release of Medical Records
• VA RD Supplement Submission Form
• VA Investigational Drug Log
• VHA Form 10-1086 Informed Consent Template
• HIPAA Notice of Privacy Practices-Summary Notice
• VHA Form 10-1223
• VHA Form 10-1313-9 Conflict of Interest
• VHA Form 10-9012
• VA Form 10-0436 Application For An Off-Site Tissue Banking Waiver

 

For additional information please contact:

Marie J. Andrews

Administrative Officer for Research (24)

Augusta VAMC

One Freedom Way

Augusta, GA  30904-6285

(706) 823-2238

(706) 823-3949 (fax)

marie.andrews@va.gov

Linda E. Ball

Resarch Program Assistant

Research Service Line

Augusta, VA  Medical 30904-6285

(706) 823-2238

(706) 823-3949 (fax)

Linda.Ball@va.gov