Forms
Forms are provided in Rich Text Format (.doc or .rtf 
), Adobe
Reader format (.pdf 
) or both.
To download a form, click on the appropriate
icon.
If you do not have the Adobe Reader, you may download it free from Adobe's Web Site.
If you have any questions about these forms, please contact us at OHRP@mcg.edu or 706-721-1478.
Initial Forms:
Click here for additional information
Form # |
Description
|
Links
|
Version Date |
HAC 100 |
Clinical Study Document Cover Sheet | |
8/08/2008 |
HAC 101 |
Protocol Information | |
10/10/2008 |
HAC 101C |
Sub-Investigator Continuation Sheet | |
4/13/2006 |
HAC 101EMG |
Emergency Exemption from Prospective HAC Approval | |
1/28/2005 |
HAC 103 |
Human Biological Specimens for Genetic Research | |
7/9/2007 |
HAC 104 |
Research Medication Data Sheet | |
12/28/2007 |
HAC 105 |
Investigational Device Information Sheet | |
12/28/2007 |
HAC 112P |
Request for Sponsor/CRO |
|
1/28/2005 |
ITSS |
Human Research-Request for Protected Space | |
|
| OHRP | CRRI/OHRP Internal Form (To be submitted to OHRP only if you are using Chesapeake Research Review, to review your protocol.) |
|
3/21/2008 |
Ongoing Forms:
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Form # |
Description
|
Links
|
Version Date |
HAC 107 |
Clinical Study Continuation Request (Contact your HAC specialist to obtain this form.) | ||
HAC 110URE/SAE |
Unexpected and Related Adverse Event (URE)/Serious Adverse Event (SAE) |
|
6/23/2008 |
HAC 113 |
Amendment Submission Form | |
8/08/2008 |
HAC 120PDV |
Protocol Deviation/Violation Report Form | |
7/9/2007 |
OHRP |
Research Self Assessment | |
7/09/2007 |
Termination Forms:
Click here for additional information
Form # |
Description
|
Links
|
Version Date |
HAC 111 |
Final Report |
|
1/28/2005 |
HAC Members:
|
Description
|
Links | Version Date |
|
| 1 | HAC Reviewers Checklist | |
4/29/2008 |
| 2 | HAC Checklist for Exempt Review | |
8/13/2008 |
| 3 | HAC Checklist for Expedited Review | |
12/17/2007 |
| 4 | HAC Checklist for Amendments | |
1/22/2008 |
| 65 | Checklist for Vunerable Populations | |
12/31/2007 |
| 6 | ICD Elements of Disclosure | |
9/07/2008 |
| 7 | Checklist of Criteria to Waive or Alter the Requirement to Obtain Informed Consent |
|
12/31/2007 |
Miscellaneous Forms:
Form # |
Description
|
Links
|
1 |
New Research Faculty Transition Form |
|
2 |
Training Requirements Checklist | |
Office of Human Research Protection
OHRP, Pavilion III, CJ-2103
1120 15th Street
Augusta, GA 30912
706-721-1478 phone
706-721-1479 fax
Angela Randazzo, ohrp@mcg.edu
All rights reserved.
