Disclaimer: Page size, page breaks, line spacing, and font size of the printed copy of each of these forms may vary depending on computer, software, and printer combinations. Therefore, it is the investigators’ responsibility to make sure that the form they use will be accepted by the HRAC office.

HIPAA Forms

• Medical Record Request Form

This form must be filled out for presentation to Medical Records at the time of the request for information.

Protocol Submissions 

• ARIA Protocol Submissions  - Contact Connie Hendrixson for your ARIA username and password.
• Application Form for HRAC Review of Research Involving Human Subjects - Behavioral and Social Sciences Submissions

Instructions on Submitting a Research Protocol for Initial Review to the Behavioral and Social Sciences IRB

Other Required Forms by Institution

UAMS

• Request for Pharmacy Cost Impact UAMS Hospital and Clinics  (MS Word 2000)

• Request to Review Research Proposal/Project and Instructions (MS Word 2000)
• Investigational Drug Information Record (MS Word 2000)
• Request for Pharmacy Cost Impact (MS Word 2000)
• Request for Cost Impact (MS Word 2000)
• VA Consent Form 10-1086

• Arkansas Children Hospital’s Submission Forms 

• Continuing Review Submission Training Handout (NEW - revised 8/19/03)