NOTICE: If you were directed to fill out a form by ORA or as part of a Data Use Agreement to be reviewed by CRIOC , please use this form instead: https://redcap.link/crioc_review
The current form is for BBMC requests including biostats/other research support and Clinical Research Data Warehouse (CRDW) data requests. If your project will involve data sharing and/or a large volume of data, you may need to submit both forms.
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The Principal Investigator is ultimately responsible for this project:
Contact First Name Last Name Role on Project Email Phone PI Principal Investigator Secondary
PI First Name
* must provide value
PI Last Name
* must provide value
PI's Email Address
* must provide value
PI's Phone Number
* must provide value
Secondary Contact's First Name
Secondary Contact's Last Name
Co-PI Sub-Investigator/Co-Investigator Study Coordinator Other Research Support Staff Fellow Resident Student
If the PI belongs to a non-college entity such as Stephenson Cancer Center, please select None for the College and enter the organization's name under Department.
PI's College PI's Department (if applicable) PI's Section (if applicable)
Primary Contact's College
Allied Health Dentistry Graduate College Medicine None Nursing Pharmacy Public Health
Primary Contact's Department
Primary Contact's Section
~ ~ ~ Please tell us about your project ~ ~ ~ Project Title
* must provide value
Does this request include BBMC CRDW retrieval of electronic medical records (such as Epic, Centricity, Meditech, etc.)?
Yes No
CRIOC (Clinical Research Informatics Oversight Committee) is the governing body charged with overseeing the use of information systems and data assets of OU Health and the clinical practices of the OUHSC Colleges for the purposes of clinical and translational research.
After you complete the current survey (ie, the "BBMC Research Support Request"), please complete
this CRIOC screener at https://bbmc.ouhsc.edu/redcap/surveys/?s=YLA8LN4J4J. In our experience, most CRDW data-extraction requests require CRIOC review. Typically within a month, CRIOC will notify you of their recommendation, such as (a) your study is exempt, (b) your study is approved, or (c) your application requires additional details.
Without both IRB and CRIOC approval or exemption, the CRDW cannot release PHI or aggregate counts to investigators.
Please provide at least one study aim (if applicable):
Study Aim 1 Study Aim 2 Study Aim 3
An IRB protocol being written
A submitted IRB protocol
An approved IRB protocol
No need for an IRB-approved protocol or the project is exempt
An IRB protocol being written
A submitted IRB protocol
An approved IRB protocol
No need for an IRB-approved protocol or the project is exempt
IRB Number
* must provide value
The IRB determined this project is not human-subjects research
No PHI is needed
Other
The IRB determined this project is not human-subjects research
No PHI is needed
Other
Please upload your IRB exemption letter.
If you have a draft protocol that you could share with us, please upload it here.Note: The BBMC will let you know the names of staff members who will need to be added as key personnel on the IRB protocol.
Please upload the submitted protocol.Note: The BBMC will let you know the names of staff members who will need to be added as key personnel on the IRB protocol.
Please upload the IRB-approved protocolNote: The BBMC will let you know the names of staff members who will need to be added as key personnel on the IRB protocol.
Please upload the IRB approval letterNote: The BBMC will let you know the names of staff members who will need to be added as key personnel on the IRB protocol.
If you have a Data Collection Form, please upload it here.
Please upload a document (if available) describing the project
~ ~ ~ The following table asks which services you are requesting. ~ ~ ~ Please note : Requests for data from the Clinical Research Data Warehouse (electronic health records) typically take 4-6 weeks to complete and are prioritized by date submitted, funding source, IRB status, etc.
REDCap Assistance Biostatistics Consultation Research Design Clinical Research Data Warehouse Manuscript Writing/Editing Data analysis Power Analysis Abstract Writing Grant Development/Submission Grant Report Project Report Presentation/Poster Protocol Development Other
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Yes No
REDCap Assistance Biostatistics Consultation Research Design Clinical Research Data Warehouse Manuscript Writing/Editing Data analysis Power Analysis Abstract Writing Grant Development/Submission Grant Report Project Report Presentation/Poster Protocol Development Other
Y-M-D
Yes No
REDCap Assistance Biostatistics Consultation Research Design Clinical Research Data Warehouse Manuscript Writing/Editing Data analysis Power Analysis Abstract Writing Grant Development/Submission Grant Report Project Report Presentation/Poster Protocol Development Other
Y-M-D
Yes No
REDCap Assistance Biostatistics Consultation Research Design Clinical Research Data Warehouse Manuscript Writing/Editing Data analysis Power Analysis Abstract Writing Grant Development/Submission Grant Report Project Report Presentation/Poster Protocol Development Other
Y-M-D
Yes No
REDCap Assistance Biostatistics Consultation Research Design Clinical Research Data Warehouse Manuscript Writing/Editing Data analysis Power Analysis Abstract Writing Grant Development/Submission Grant Report Project Report Presentation/Poster Protocol Development Other
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Yes No
Do you have an existing BBMC contact person for this request?
Yes No
*CRIOC Only Adon Rosen Andrew Peters Arnold Kanagwa Ashley Thumann Caxton Muchono Chris Aston Connor Garbe David Bard Donna Wells Geneva Marshall Lise DeShea Mike Anderson Sixia Chen Thomas Wilson Will Beasley Xiaolan Liao Yaqi Li Yutian Thompson
Please supply the e-mail address for the individual who will be conducting statistical analysis on CRDW data.
When possible, we would prefer this individual join the initial discussion to help guide CRDW team on how to best structure data to support the study's research question(s) and intended analyses.
You have not entered a statistician's email address. Please be aware that data will typically be provided in comma separated value (csv) files or uploaded into a REDCap project, and the CRDW team is not typically responsible for extensive reformatting or guidance on analysis. If analysis is being performed by a resident or other party who may need assistance with statistical analysis, please let us know, and we can suggest resources for support.
~ ~ ~ Please answer the following questions. ~ ~ ~ This project is currently funded.
* must provide value
Yes No
The project receives:
* must provide value
Federal funding
Funding from another source
Federal funding
Funding from another source
Please upload your grant award letter.
Please upload a copy of your approved grant application.
A grant has been submitted and is under review for this project.
* must provide value
Yes No
A grant is being written for this project.
* must provide value
Yes No
The project lays groundwork for a future grant application and/or funding.
* must provide value
Yes No
The BBMC must report to our funding sources on the kinds of projects we have supported. The availability of our services depends on your answers. Please choose all categories that fit your project. Underlined phrases have pop-up balloons with definitions. This project involves ... Quality improvement Scientific research Other scholarly activity for future publication Program evaluation Academic activities Business analytics Health economics Health systems Dissemination/implementation science Outcomes research Feasibility assessment Preparatory to research Data extraction for recruitment or analysis National registry contribution Retrospective chart review
Quality improvement
* must provide value
Yes No
Scientific research
* must provide value
Yes No
Other scholarly activity for future publication
* must provide value
Yes No
Program evaluation
* must provide value
Yes No
Academic activities
* must provide value
Yes No
Business analytics
* must provide value
Yes No
Health economics
* must provide value
Yes No
Health systems
* must provide value
Yes No
Dissemination/implementation science
* must provide value
Yes No
Outcomes research
* must provide value
Yes No
Feasibility assessment
* must provide value
Yes No
Preparatory to research
* must provide value
Yes No
Data extraction for recruitment or analysis
* must provide value
Yes No
National registry contribution
* must provide value
Yes No
Retrospective chart review
* must provide value
Yes No
Please explain how you would categorize your project that may be different from the categories above.
* must provide value
Please add anything else you want the BBMC to know about your request.
Note:
~ ~ ~ Now that you have completed the request, please click Submit. Thank you! ~ ~ ~