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- Forms, Tools, & Templates Description Category(ies) Keyword(s)
- Cost Finder Tool with research rates for both Hospital Billing (HB) and Professional Billing (PB), components of an item/service/procedure. Select at least one entity (HUP, PPMC, PAH OR CCH) prior to searching.Pricing may vary by entity. Ability to search by CPT code (preferred) or procedure name. OCR Applications; Study Start-Up Cost Finder, finance, start up ,
- Closing an IND Guide to Sponsor How to discontinue an IND with the FDA. Definitions of the various IND statuses are included below for reference purposes. IND IND, Sponsor, FDA ,
- IND Application Template Template for an application to the FDA for an Investigational New Drug (IND) IND; IDE; Sponsor IND, Sponsor, FDA ,
- Good Laboratory Practice (GLP) Qualification Guide Guide to ensuring vendors providing investigational product are qualified and follow Good Laboratory Practices IND; IDE; Sponsor Third Party/Vendors; Sponsor; Investigational Product ,
- Investigator Brochure Template Guide for developing an Investigator's Brochure Trial Documents Trial Document; Investigator; brochure ,
- Principal Investigator (PI) Qualification Form Template for documenting the qualifications of a Principal Investigator Third Party/ Vendors PI; Qualification, principal investigator ,
- Understanding Using an EDC - PennCRMS W Understanding Using an EDC - PennCRMS Workflows Data Management; Sponsor; Source Documentation edc, crms, sponsor, source, crf ,
- Database Lockdown Checklist and CRMS Examples Database Lockdown Checklist and CRMS Examples Data Management; Sponsor; Source Documentation edc, sponsor, crms, source ,
- Testing CRFs Overview in PennCRMS Testing CRFs Overview in PennCRMS Data Management; Sponsor; Source Documentation edc, sponsor, crf, crms, data management ,
- CRF Testing Tracker CRF Testing Tracker Data Management; Sponsor; Source Documentation edc, sponsor, crf, crms, data management ,
- CRF Testing Script - Blank Template CRF Testing Script - Blank Template Data Management; Sponsor; Source Documentation edc, sponsor, crf, crms, data management ,
- PennCRMS CRF Guidelines and Tips PennCRMS CRF Guidelines and Tips Data Management; Sponsor; Source Documentation edc, sponsor, crf, crms, data management ,
- CRF build and Schedule of Events tracker CRF build and Schedule of Events tracker Data Management; Sponsor; Source Documentation edc, sponsor, crf, crms, data management ,
- Database Activation Authorization Database Activation Authorization Data Management; Sponsor; Source Documentation edc, sponsor, crf, crms, data management ,
- Electronic Database Build and Activation Summary Plan Electronic Database Build and Activation Summary Plan Data Management; Sponsor; Source Documentation data management , sponsor, source documentation ,
- CLIA, CAP, Lab References and Lab Director’s CV_HUP CLIA, CAP, Lab References and Lab Director’s CV. Documents obtained annually and posted with permission from Dept. of Pathology and Laboratory Medicine, Penn Medicine-HUP Regulatory File/ Investigator Site File; Source Documentation CLIA, CAP, Lab References ,
- CLIA, CAP, Lab References and Lab Director’s CV_PRESBY CLIA, CAP, Lab References and Lab Director’s CV. Documents obtained annually and posted with permission from Dept. of Pathology and Laboratory Medicine, Penn Medicine-Presbyterian Regulatory File/ Investigator Site File; Source Documentation CLIA, CAP, Lab References, Presby ,
- Case Report Form Amendments Log Track Case Report Form (CRF) versions and changes Regulatory File/ Investigator Site File CRF ,
- Clinical Research Resource Feasibility Assessment Budget/ Finance ,
- Clinical Trial Protocol Template This protocol template is designed to help research teams develop a clinical trial protocol that includes an investigational intervention (drug, biologic, vaccine or device). Protocol Templates ,
- Close Out Visit Checklist - Investigator Checklist for closing out a protocol Monitoring ,
- Close Out Visit Checklist- Sponsor Investigator Checklist for closing out a protocol by a Sponsor or Sponsor Investigator Monitoring ,
- Closing IDE Guide to Sponsor How to discontinue an IDE with the FDA. Definitions of the various IDE statuses are included below for reference purposes. IDE ,
- Correspondence Log Log for documenting correspondence including the date, time, participants, and summary of discussion Project Management ,
- Data Safety Monitoring Plan (DSMP) With Guidance This template is intended to be used to develop a data safety monitoring plan. Monitoring ,
- Delegation of Responsibility and Signature Log Document study personnel and their role on the study, as delegated by the Principal Investigator. Also serves as a signature log to identify signatures on research forms. Regulatory File/ Investigator Site File ,
- Device Investigational Plan Template Guide to developing an Investigational Plan for medical device research IDE ,
- Device Product Information This guidance document assists US IDE, IND, and foreign clinical research device applicant holders in determining what product information is needed and where to place device product information. IDE ,
- DSMB Contact List Used to compile contact information for the DSMB members and their administrative support staff. May be useful as a reference during trial progress. DSMB ,
- DSMB Meeting Minutes Used to document discussions during DSMB meetings. Includes documentation of attendance and disclosure of financial conflicts. DSMB ,
- DSMB Outcome Email Letter Used to document the outcome of the DSMB meeting to provide to the PI(s). The PI may need this confirmation to provide to their IRB or other local regulatory review committee. DSMB ,
- DSMB Qualification Used to document potential DSMB member's agreement to serve as part of the DSMB. Includes description of confidentiality and disclosure of financial conflict of interest provisions. DSMB ,
- DSMB Report Used to provide a summary of trial data to the DSMB. Specific section will differ by study, may be revised based on DSMB request. DSMB ,
- Electronic Data Management Tool This tool is used to assist the determination of what data management tool would be most beneficial for your research study. Budget/ Finance ,
- Notice of Disclosure of FCOI Template for written disclosure of FCOI IND; IDE; Sponsor ,
- GLP Qualification Guide Guide to ensuring vendors providing investigational product are qualified and follow Good Laboratory Practices IND; IDE; Sponsor ,
- GLP Vendor Qualification Form Template to qualify non-clinical vendors Third Party/ Vendors ,
- ICH GCP Essential Documents Table of regulatory files that should be maintained by the PI and Sponsor throughout a clinical research study Regulatory File/ Investigator Site File ,
- IND Enabling Nonclinical Safety Study Work Instructions These work instructions are intended as guidance for personnel who (i) conduct or assist in the conduct of Nonclinical Safety Studies (NSS) to be submitted in support of an IND Application or (ii) have oversight of such activities. Although such studies usually occur prior to the submission of an IND, these work instructions also apply to NSS performed after IND approval and in support of clinical development. If an individual is subject to a FINANCIAL CONFLICT OF INTEREST (FCOI) management plan issued by the Vice Provost for Research, the conditions of the management plan will apply to the conduct of NSS. IND ,
- IND-IDE Submision Planner Checklist to assist in preparing the final IND/IDE application package to be submitted to FDA. IND; IDE ,
- Informed Consent Form (ICF) Version Log Tracking log of approvals for Informed Consent Form Regulatory File/ Investigator Site File ,
- Investigational Device Exemption (IDE) Application Instructions Instructions for completing the application for an Investigational Device Exemption (IDE) IND; IDE; Sponsor ,
- Investigational Device Exemption (IDE) Application Template Template for an application to the FDA for an Investigational Device Exemption IND; IDE; Sponsor ,
- Investigational Device Exemption (IDE) Cover Letter Template Template cover letter to accompany the Investigational Device Exemption (IDE) application IND; IDE; Sponsor ,
- Investigational New Drug (IND) Application Template Template for an application to the FDA for an Investigational New Drug (IND) IND ,
- Investigational Product Accountability Study Log Study-level investigational product accountability log (all subjects on one log) Sponsor ,
- Investigational Product Accountability Subject Log Subject specific investigational product accountability log Sponsor ,
- Investigator’s Brochure Addendum Log Track versions of the Investigator’s Brochure Trial Documents ,
- Memo from Penn IRB Memo from Penn IRB regarding the IRB not disclosing names of its members. This is a necessary component of the IDE application. IDE ,
- Monitoring Analysis Template This tool is intended to assist in the planning for monitoring a clinical trial. Monitoring ,
- Monitoring Assessment Guidance Document This document is designed to assist study teams with completing an appropriate monitoring summary for the Penn IRB at the time of continuing review. Monitoring ,
- Monitoring Close Out Visit Template Monitoring visit report template for the conduct of a close out monitoring visit at the end of a clinical trial. Monitoring; Sponsor; Trial Master File ,
- Note to File Template To be used to create a Note to File which are written to identify a discrepancy or problem in the conduct of the clinical research study. Regulatory File/ Investigator Site File ,
- On-Site Query Report Form Worksheet for documenting the identification and resolution of queries Monitoring ,
- PI Qualification Form Template for documenting the qualifications of a Principal Investigator Sponsor ,
- Participant Visit Schedule Tool for tracking the proposed and actual dates for subject study visits Study Start-Up ,
- PennChart - Patient Registration Form EMPI If you need your patient/subject setup in PennChart within 24 hours Budget/ Finance ,
- Pre-Screen Phone Script (Incoming Call) Pre-screen phone script template for incoming calls from potential research participants IND; Recruitment; Regulatory File/ Investigator Site File ,
- Pre-Screen Phone Script (Outgoing Call) Pre-screen phone script template for outgoing calls to potential research participants Recruitment; Regulatory File/ Investigator Site File ,
- Principal Investigator Compliance Assessment (PICA) The Principal Investigator Compliance Assessment (PICA) is a tool which can be used to monitor or assess the overall conduct of a study. This document is required for all active, high risk studies conducted at Penn. Monitoring ,
- Prospective Study Design with no Investigational Product (IP) Template Use this template to develop a clinical research protocol that does not involve an investigational product. E.g. Comparative effectiveness study, a cohort design, case control study, etc. Protocol Templates ,
- Prospective Reimbursement Analysis/ Medicare Coverage Analysis - Budget Template Template for completing the prospective reimbursement analysis/ medicare coverage analysis and industry sponsored clinical research budget. Budget/ Finance; Regulatory File/ Investigator Site File ,
- Protocol Amendments Log Track versions of the IRB approved Protocol Regulatory File/ Investigator Site File ,
- Protocol Deviation Log To track all protocol deviations. Regulatory File/ Investigator Site File ,
- Protocol Training Log Log for documenting the training of research personnel on the research protocol Regulatory File/ Investigator Site File ,
- Qualifying Vendor - Manufacturing Activities The Sponsor (IND/IDE/CTA holder or lead PI among multiple PIs w/no IND,IDE,CTA) places document in TMF IND; IDE; Sponsor ,
- Recording, Assessment, and Reporting of Deviations This document aims to help teams with the recording of deviations and exceptions of an approved protocol, and the reporting requirements to the Penn IRB and Sponsor IND; IDE; Regulatory File/ Investigator Site File; Sponsor ,
- Recruitment Letter - Physician to Established Patient Template for recruitment letter from an external, referring physician to his/her patient about a research study Recruitment ,
- Recruitment Letter - Physician to Physician Letter Template Template for recruitment letter from one physician to another about a research study Recruitment ,
- Recruitment Letter – PI to Patient Template Template for recruitment letter from the Principal Investigator to his/her patient about a research study Recruitment ,
- Recruitment Letter- Physician to Unknown Potential Subject Template for recruitment letter from a physician to a potential research subject about a research study Recruitment ,
- Regulatory History Log Template for tracking all regulatory submissions of an IND/IDE IND; IDE; Sponsor ,
- Reportable Event Form (Electronic) Form for capturing the details of a Reportable Event for informing a sponsor, manufacturer, or other reporting entity Regulatory File/ Investigator Site File ,
- Reportable Event Form (Paper) Form for capturing the details of a Reportable Event for informing a sponsor, manufacturer, or other reporting entity Regulatory File/ Investigator Site File ,
- Residual Balance Transfer Request Form Form used to request the residual balance to be transferred from appropriate contracts Budget/ Finance ,
- Retrospective Study Protocol Template This protocol template is designed to facilitate the creation of a retrospective clinical research protocol. Protocol Templates ,
- Risk Assessment Template for performing a clinical trial risk assessment for monitoring Monitoring ,
- Screening and Enrollment Log Document subjects who have been screened and/or enrolled Recruitment; Regulatory File/ Investigator Site File ,
- Single Patient Emergency Use of an Investigational Product Guide to requesting and managing a single patient emergency use of an investigational product. IND; IDE; Sponsor ,
- Site Guidance for Source Documentation This document contains information about Source Documentation for clinical trials. Regulatory File/ Investigator Site File ,
- Site Initiation Visit Checklist Checklist for conducting a Site Initiation Visit IND; IDE; Sponsor ,
- Site Qualification Report Tool for documenting the review and qualification assessment of a site and principal investigator Monitoring; Regulatory File/ Investigator Site File ,
- Site Visit Log Document the dates of Monitoring Visits Monitoring ,
- Specimen Preparation Checklist Instructions for collecting, labeling and processing specimens for shipment Regulatory File/ Investigator Site File ,
- Specimen Shipping Log Log the collection and shipment of specimens Regulatory File/ Investigator Site File ,
- Sponsor - IDE Investigator List Template for the submission to the FDA-CDHR of the semi-annual list of investigators required by 21CFR 812.150 Monitoring; Regulatory File/ Investigator Site File ,
- Sponsor Monitoring Plan Guide Guide for developing an IND/IDE sponsor's monitoring plan IND; IDE; Sponsor ,
- Sponsor Welcome Letter Template for use in negotiating with an industry sponsor. Budget/ Finance ,
- Study Admin File_Device Template for developing a study administration file or regulatory binder for a device trial Regulatory File/ Investigator Site File ,
- Study Admin File_Social Behavioral Template for developing a study administration file or regulatory binder for a social behavioral study Regulatory File/ Investigator Site File ,
- Study Admin File_Drug Template for developing a study administration file or regulatory binder for a drug trial Regulatory File/ Investigator Site File ,
- Study Feasibility Assessment Tool for assessing the resources, recruitment potential, and logistical considerations of a particular study Study Start-Up ,
- Subject Contact Information Sheet Collect contact information for research subjects Source Documentation ,
- Subject Eligibility Checklist Template for documenting review of Inclusion and Exclusion criteria Source Documentation ,
- Transfer of Obligations Guide Guide to transferring IND/IDE sponsor obligations to another party IND; IDE ,
- Trial Master File Template for a Trial Master File Trial Master File ,
- Monitoring Visit Report - Sponsor Summary Template for reporting monitoring findings to Sponsor Monitoring ,
- Monitoring Visit Tracking Log Log used to document monitoring visits over the course of a trial Monitoring ,
- W-9 IRS Form (No Form) Federal form used to report income paid to an individual Budget/ Finance ,
- Vendor Qualification Guide Guide to qualifying a vendor IND; IDE; Sponsor ,
- DSMB Charter Used to clearly describe how the DSMB will function, including frequency of meetings, data to be reviewed, how safety items will be communicated, etc. DSMB ,
- Investigational Device Exemption (IDE) Application Template Template for an application to the FDA for an Investigational Device Exemption IND; IDE; Sponsor ,
- Investigator New Drug (IND) Annual Report Template Template for completing an IND Annual Report IND ,
- CRSPR Email Listserve Clinical Research Staff Portal and Registry (CRSPR) is an email listserve to communicate important, timely information to Penn Medicine's Clinical Research Professionals. Needs PennKey login. Sign up by creating a profile, to receive emails from OCR, IRB, CHPS, etc. OCR Applications CRSPR, listserve, application, email, portal, registry ,
- Research Billing Application (RBA) All studies utilizing UPHS services/procedures and/or Imaging Core/Service Center(s) will need to be registered in the Research Billing Application (RBA), regardless of the payor (insurance or research grant). A Research Billing Number (RBN) will be generated for those studies where all or a portion of visits/tests/procedures associated with the research protocol are being billed to the research grant. OCR Applications RBA, billing, research billing application, hospital, services, grant, payor, insurance ,
- 21 CFR Part 11 for EMR Memo- Penn Medicine Electronic Health Records in Support of Clinical Research Communication; Study Start-Up part 11, 21 cfr part 11, EMR, compliance, pennchart ,
- IND-IDE Sponsor Responsibilities Guide Responsibilities of an IND/IDE Sponsor IND; IDE ,
- IDE Progress Report_Template Template for completing an IDE Progress Report IDE ,
- Expanded Access eIND Instructions for submitting an emergency IND request IND ,
- Expanded Access sIND Instructions for submitting a (compassionate use) single patient IND request IND ,
- 03.01.01 Submitting to the FDA This document describes the different way a submission can be sent to the FDA. It applies to clinical research (IND/IDE) and also to Expanded Access of drugs and devices. Sponsor ,
- Pharmacovigilance Work instructions on sponsor pharmacovigilance (safety) management. This includes a discussion of the sponsor responsibilities related to pharmacovigilance, as well as instructions on conducting the activities, and additional reference resources. Sponsor ,
- Work Instructions TMF – PennBox Instructions explaining training requirements, user roles, access, and use of the TMF in the Veeva Vault system Trial Master File Penn Box ,
- Work Instructions TMF – Veeva Instructions explaining training requirements, user roles, access, and use of the TMF in the PennBox system. Trial Master File Veeva ,
- Statement of Investigator The investigator agreement of compliance to all requirements of the investigational plan, IDE regulations, and other applicable regulations of the FDA for investigational devices. IDE ,
- SAE Form Form used to document an SAE that occurs in a trial and to report the relevant information to the sponsor. Trial Documents ,
- Monitoring Findings Template Monitoring Findings Template Monitoring findings, monitoring, site ,
- Protocol Adverse Event Log A Log for recording adverse events Regulatory File Adverse Event, Adverse, Event, Log ,
- IND IDE Exemption Amendment Risk Assessment This form provides instructions, and may be used to document, the Sponsor Investigator’s risk assessment for minor changes to a protocol that has previously received an IND or IDE exemption determination. Protocol Templates; Sponsor ,
- RBA New Request Tipsheet Tipsheet with steps on how to submit a new request for a Research Billing Number in the Research Billing Application Budget/ Finance; OCR Applications; Project Management; Study Start-Up RBA, Research Billing Application, Finance, RBN, billing number ,
- RBA Business Admin Approval Tipsheet Tipsheet for the RBA. Shows how to route request for RBN to your BA and OCR Finance for RBN creation Budget/ Finance; OCR Applications; Project Management; Study Start-Up RBA, RBN, Research Billing application, Research Billing number, finance, BA ,
- 09.01.01 Manufacturing Evaluation The form to be used by Sponsors to conduct an initial manufacturing evaluation of quality for manufacturers. Sponsor; Third Party/ Vendors; Trial Master File