|
VA
Credentialed Physicians - Contract Status
1)
Documentation of
Human Subjects Training and VA Security Training
2) Without
Compensation (WOC) appointment for Research Privileges added to credentialing
status (memo to the Medical Staff Office signed by appropriate Service Chief)
3) Signed
Intellectual Property Agreement (IPA)
4) Conflict of Interest Form
VA
Credentialed Physicians – VA Salaried
1) Documentation of Human Subjects Training and Security Training
Fellows, Med Students, and Residents-
1) Documentation of
Human Subjects Training and VA Security Training
2) Copy of
appointment memo (obtained from the VA Education Office x.15109)
3) Signed
Intellectual Property Agreement (IPA)
4) Scope of
Practice
5) Conflict of Interest Form
Other
1) Documentation of Human Subjects
Training and VA Security Training
2) If NOT VA
salaried, WOC appointment (submit through the appropriate service)
3) Signed Written
Release of Information
4) Signed
Intellectual Property Agreement (IPA) – FOR WOC’s ONLY
5) Scope of Practice
6) Conflict of Interest Form
Exempt*
1) Documentation of VA
Security Training
2) Memorandum from PI
denotes what their role in the study will be (specify contact with research subject(s) and data access)
3) Conflict of Interest Form
*
|