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Forms and Templates

Please note that only the consent templates found in this section are acceptable format for use in the ERSA system.
Consent Forms

AE / IND Report Log
Created Date:  1/29/2008 1:09 PM
Type: Word (.doc file)
 
Anonymous Questionnaire Consent Template
Created Date:  12/16/2013 4:41 PM
Type: Word (.docx file)
 
Blood and Tissue Verbiage
Created Date:  1/29/2008 1:07 PM
Type: Word (.doc file)
 
Consent Addendum Ochsner IRB with HIPAA_v2017 01.docx
Created Date:  12/30/2008 12:48 PM
Type: Word (.docx file)
 
Consent MAIN Template with HIPAA_v2017 01.docx
Created Date:  1/29/2008 1:08 PM
Type: Word (.docx file)
 
Consent Registry Ochsner IRB with HIPAA_v2017 01.docx
Created Date:  10/23/2009 3:17 PM
Type: Word (.docx file)
 
Employee non-coercion statement
Created Date:  6/19/2005 10:27 PM
Type: Word (.doc file)
 
HIPAA Authorization
Created Date:  1/29/2008 1:09 PM
Type: Word (.doc file)
 
HIPAA Authorization Revocation Form
Created Date:  8/6/2008 3:17 PM
Type: Word (.doc file)
 
HIPAA Notice Preparatory to Research
Created Date:  4/21/2009 4:04 PM
Type: Resource (.rtf file)
 
HUD Surgical Consent Addendum_v. 2012.03.01
Created Date:  8/3/2007 10:05 AM
Type: Word (.doc file)
 
LSU - Ochsner Combined Consent Template_2013.07
Created Date:  9/14/2009 8:52 AM
Type: Word (.docx file)
 
LSU - Ochsner Combined HIPAA Authorization
Created Date:  12/26/2010 8:15 PM
Type: PDF (.pdf file)
 
Pediatric Assent Signature Box ages 13-17
Created Date:  1/29/2008 1:10 PM
Type: Word (.docx file)
 
Pediatric Assent_12 Years of Age and Younger
Created Date:  5/18/2006 8:24 AM
Type: Word (.docx file)
 
PI.Presenters.doc
Created Date:  10/22/2015 9:47 AM
Type: Word (.doc file)
 
Protocol Deviation Log
Created Date:  1/29/2008 1:11 PM
Type: Word (.doc file)
 
Sample chart review protocol
Created Date:  8/5/2014 3:22 PM
Type: Word (.doc file)
 
Telephone Consent Template
Created Date:  1/29/2008 1:11 PM
Type: Resource (.rtf file)
 
Misc Documents

Consent Guidance_September 2011
Created Date:  6/29/2010 4:44 PM
Type: Word (.doc file)
 
Consent Initial Footer Memo_June 2010
Created Date:  6/29/2010 4:42 PM
Type: Word (.doc file)
 
Corrective Action Plan - Guidance and Sample
Created Date:  10/8/2008 7:22 AM
Type: Word (.doc file)
 
Corrective Action Plan_Blank Sample
Created Date:  4/17/2012 2:06 PM
Type: Word (.doc file)
 
Disaster Information Letter - Device
Created Date:  1/29/2008 1:12 PM
Type: Word (.docx file)
 
Disaster Information Letter - Drug
Created Date:  1/29/2008 1:12 PM
Type: Word (.docx file)
 
Disaster Wallet Cards
Created Date:  5/20/2010 4:31 PM
Type: Word (.docx file)
 
IND Exemption Checklist_2009
Created Date:  1/29/2008 1:12 PM
Type: PDF (.pdf file)
 
Ochsner HIV Consent_Form 3772
Created Date:  2/12/2009 1:48 PM
Type: PDF (.pdf file)
 
Part B - Pregnant Women and Fetuses
Created Date:  7/21/2008 10:48 AM
Type: Word (.doc file)
 
Partial HIPAA Waiver Request
Created Date:  4/22/2009 11:15 AM
Type: Word (.doc file)
 
Protocol Format Guidance
Created Date:  1/29/2008 1:13 PM
Type: PDF (.pdf file)
 
Protocol Template
Created Date:  1/29/2008 1:13 PM
Type: Word (.doc file)
 
Study Flyer Template
Created Date:  5/22/2008 4:18 PM
Type: Word (.doc file)
 
Consent Short Forms

Arabic
Created Date:  1/29/2008 1:14 PM
Type: PDF (.pdf file)
 
Chinese
Created Date:  8/5/2009 2:33 PM
Type: PDF (.pdf file)
 
English Version for Translation -- Do not use to consent
Created Date:  1/29/2008 1:14 PM
Type: PDF (.pdf file)
 
French
Created Date:  1/29/2008 1:14 PM
Type: PDF (.pdf file)
 
Spanish
Created Date:  1/29/2008 1:14 PM
Type: PDF (.pdf file)
 
Use of Short Forms Guidance
Created Date:  1/29/2008 1:15 PM
Type: PDF (.pdf file)
 
Vietnamese
Created Date:  1/29/2008 1:15 PM
Type: PDF (.pdf file)