This database will contain specific information on patients seen within the mental health clinic at the VA. It will be available to query, with IRB permission, for feasibility of participation in certain studies as well as for new projects to be conducted by Dr. Smith and other researchers. The clinical data alone, or in combination with basic science parameters, will be used to study the epidemiology, pathogenesis, pathophysiology and classification of specific disease processes treated by the PI of this repository. Data Description and Source Data Type: Data collected will be identified and include protected health information (PHI). The following is a list of the specific fields in the database: Name SSN Address Date of Birth Age Sex Race Weight/Height Medical Record Number Physicians (i.e., urologist, pediatrician, referral physician, surgical team) Diagnoses/Dates/Codes Past Medical History/Family History Hospital Admissions/Dates/Units Hospitalized in Medications Allergies Lab Results X-Rays Symptoms/Scores Post-op Care/Treatment Current Research Patient – The data obtained for the research is necessary to conduct the research. Name, date of birth, and medical record number will be used to assist in ensuring the correct patient’s data is being collected. Address will be collected in case there is a need to contact a patient to verify data. Data Source: Data in the repository will be come from study visits as well as CPRS. Data will not be accepted in this data repository without a signed approved informed consent document and HIPAA authorization. Data Collection: The data fields specified will be collected via medical record review by an approved
This database will contain specific information on patients seen within the mental health clinic at the VA. It will be available to query, with IRB permission, for feasibility of participation in certain studies as well as for new projects to be conducted by Dr. Smith and other researchers. The clinical data alone, or in combination with basic science parameters, will be used to study the epidemiology, pathogenesis, pathophysiology and classification of specific disease processes treated by the PI of this repository. Data Description and Source Data Type: Data collected will be identified and include protected health information (PHI). The following is a list of the specific fields in the database: Name SSN Address Date of Birth Age Sex Race Weight/Height Medical Record Number Physicians (i.e., urologist, pediatrician, referral physician, surgical team) Diagnoses/Dates/Codes Past Medical History/Family History Hospital Admissions/Dates/Units Hospitalized in Medications Allergies Lab Results X-Rays Symptoms/Scores Post-op Care/Treatment Current Research Patient – The data obtained for the research is necessary to conduct the research. Name, date of birth, and medical record number will be used to assist in ensuring the correct patient’s data is being collected. Address will be collected in case there is a need to contact a patient to verify data. Data Source: Data in the repository will be come from study visits as well as CPRS. Data will not be accepted in this data repository without a signed approved informed consent document and HIPAA authorization. Data Collection: The data fields specified will be collected via medical record review by an approved
Research_Data_Repository_SOP_Template_SAMPLE.docx