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Application Materials

If you have any questions about application materials or the process, please contact us.

  • Adverse Event / Unanticipated Problem Report Form
  • Amendment / Modification Form
  • Application for Humanitarian Use Device
  • Emergency Use Consent Form Template
  • Emergency Use Report
  • Enrollment Closure Form
  • Final Study Closure Application
  • Informed Consent Checklist
  • IRB Application for Initial Review
  • IRB Continuation Form
  • IRB Determination Form
  • IRB Fee Schedule
  • Protocol Closure or Suspension Form
  • Protocol Deviation Report Form
  • Request for Exemption

Supplemental Forms:

  • Additional Research Personnel
  • Financial Conflict of Interest Disclosure Form
  • Multiple Adverse Events Reporting Form
  • Research Involving Cognitively Impaired Individuals
  • Research Involving Stored Data for Future Use
  • Request for Approval of Deception in Research
  • Request for Waiver of Consent
  • Request for Waiver of Written Consent
  • Use of Internet in Human Participants Research
  • Waiver of HIPAA Authorization

Policies & Procedures:

  • Continuing Review Request

Colquitt Regional does not currently conduct or support studies involving prisoners, pregnant women, human fetuses or neonates.

Colquitt Regional Medical Center

3131 South Main Street
P.O Box 40
Moultrie, GA 31768

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(229) 985-3420
info@colquittregional.com

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