Legacy IRB Forms

Mandatory Use of Click IRB

As of March 1, 2016, all work – new applications, modifications, renewals, etc. – will need to be submitted to the IRB via Click unless otherwise directed by the HSPP staff. The items available here are for use with the legacy system only. Do not upload these documents into Click, or you will be asked to withdraw your submission and re-submit using Click documents. Updated materials needed for use with Click IRB submissions are available in the Click Library. For a complete listing of the documents available in the Library, view the Click Document List found on the IRB Resources page.

Legacy IRB Forms

  • Assent Form Template
  • Consent Form Template
  • Consent Form and Assent Form Checklists for Researchers
  • Short Form: Consent for Use with Language Minorities (Limited– or Non–English-Speaking Families)
  • Emergency Use Consent Form Template


  • HIPAA Authorization: Permission to Use, Create and Share Health Information for Research
  • Research Disclosure Tracking

Patient Data Request Forms

  • HIM Patient Data Request
  • Research Chart Pull Request