If YES, please explain for what purpose the specimen will be used If your study involves tissue banking, please fill out the following 6 questions below: What type of research is to be done with the specimens? (e.g. in the future etc…) Describe how and where specimens will be stored. If specimens will be linked to individually identifiable information (e.g. name, ID#, code) describe how the privacy of research participants and the confidentiality of their data will be protected: Describe who will have access to the specimens including the requirements for access, and who has control of this access: Describe the procedures in place for research participants to withdraw their specimens or whether de- identification makes withdrawal impossible: Is the banking of the specimens optional? Yes No. If NO, the informed consent should adequately explain that participation in the means the specimens will be stored indefinitely for future use or explain when the samples will be destroyed. 12) PRIVACY & CONFIDENTIALITY What will be done to ensure the privacy of the research participant? (e.g., use of curtains, drapes, closed room) What will be done to ensure the confidentiality of the research participants data ? (e.g. data access, data security, data disclosure, destruction of identifiers, storage, and coding)
If YES, please explain for what purpose the specimen will be used If your study involves tissue banking, please fill out the following 6 questions below: What type of research is to be done with the specimens? (e.g. in the future etc…) Describe how and where specimens will be stored. If specimens will be linked to individually identifiable information (e.g. name, ID#, code) describe how the privacy of research participants and the confidentiality of their data will be protected: Describe who will have access to the specimens including the requirements for access, and who has control of this access: Describe the procedures in place for research participants to withdraw their specimens or whether de- identification makes withdrawal impossible: Is the banking of the specimens optional? Yes No. If NO, the informed consent should adequately explain that participation in the means the specimens will be stored indefinitely for future use or explain when the samples will be destroyed. 12) PRIVACY & CONFIDENTIALITY What will be done to ensure the privacy of the research participant? (e.g., use of curtains, drapes, closed room) What will be done to ensure the confidentiality of the research participants data ? (e.g. data access, data security, data disclosure, destruction of identifiers, storage, and coding)
ApplicationforExpeditedorFullReview05.02.2017.docx