The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

Working …

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

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RDS Request Form

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If you experience any challenges viewing or navigating this form, you can open the survey in a new REDCap window by navigating to https://redcap.link/rds_request, or by clicking the highlighted link.

Regenstrief Data Services (RDS) Request Form

Please complete the form below with information about your project.

Upon receipt of the completed form, a member of our Operations Team will contact you to discuss specific project requirements.

If needed, information on RDS services, data sources, and available data can be found on our website at https://www.regenstrief.org/rds/. More in-depth information can be found in our Data Guide.

Principal Investigator

The PI listed here should match formal documentation, including funding proposals and IRB submissions.

First Name * must provide value
Last Name * must provide value
Email * must provide value
Role * must provide value

If other, please provide role:

Principal Investigator Institution

* must provide value

IU School of Medicine Department Other

Company/Organization if other than those listed above

Please note: all projects receiving data through Regenstrief Data Services must have Indiana University (IU) IRB approval. If you would like assistance identifying a collaborator at IU so that you can submit to the IU IRB, we recommend you use the IN CTSI "Ask A Navigator" request form at https://indianactsi.org/about/navigator/.

Please note: all projects receiving data through Regenstrief Data Services must have Indiana University (IU) IRB approval. If you would like assistance identifying a collaborator at IU so that you can submit to the IU IRB, we recommend you use the IN CTSI "Ask A Navigator" request form at https://indianactsi.org/about/navigator/.

Team members and contact information

Role	First Name	Last Name	Email
Co-Principal Investigator
Co-Investigator
Project Manager
Business Manager/Pre-award Administrator * must provide value Note: This is the person who will be handling invoices and other financial pieces for the team.

Co-Investigator Name (First)

Co-Investigator Name (Last)

Co-Investigator(s) E-mail

Project Manager phone number

Business Manager/Pre-award Administrator phone number

Contact person for this request, or person submitting this form if not the PI

First Name
Last Name
Email

Additional email addresses to be copied on all communications regarding this request (provide up to three, separated by commas):

Have you worked with RDS previously?

* must provide value

Yes

No

Have you been in contact with anyone in RDS regarding this project and/or request?

* must provide value

Yes

No

Please provide the name of your contact in RDS

For descriptions of the services offered below, please open the attached document below:

Attachment:Descriptions of RDS Services 13Jan26.pdf

What services are you requesting today?

Please reference the attachment below for definitions of each service, as well as for Rapid and Standard services.

Do you need an informal estimate and/or formal quote for proposed work? * must provide value
Are you requesting a feasibility service (aggregate counts to support a proposal or hypothesis)? * must provide value
Are you submitting a data request (the project has IRB approval and the team is ready to move forward with a request for a dataset, recruitment list, or similar service)? * must provide value
I would like to receive information about available data sources and Data Core services.
Are you requesting another type of service? * must provide value	Describe the other service requested: * If another type of service is selected, the description field may not be left blank

Did you run any feasibility assessments in ATLAS before submitting this request?

To request access to ATLAS:
1. Navigate to Regenstrief's Self Service Data Access form while connected through an IU network or VPN.
2. Read and accept the Data Use Conditions.
3. Under "Data Source" select "INPC OMOP (OHDSI ATLAS)" and fill out the form with your information.

Yes

No

Please provide the cohort name (and number if available) used for your feasibility assessments.

Does this project (or department) have a funded contract for a designated RDS employee?

* must provide value

Which RDS team member should be assigned to this request?

Are you new to working with EHR/HIE data and interested in consultation with a medical/informatics expert at CTSI to help guide your data request?

Yes

No

Project Title

* must provide value

Expand

Deadline for receipt of the informal estimate/quote:

This is the day by which the study team needs to receive the quote from RDS in order to meet their timeline.

Please allow at minimum 5 days for the completion of an informal estimate or quote request.

* must provide value

M-D-Y

The Regenstrief Data Services meets with each research team for a project alignment call. This allows us to provide the requested estimate or quote as efficiently and accurately as possible. Please use the following link to schedule your call:
Regenstrief Project Alignment Call Scheduling

I confirm I have used the link above to schedule a Project Alignment Call with RDS.

* must provide value

Yes

No

If the estimate or quote is needed for an external funding proposal, what is the due date for submission to the sponsor?

M-D-Y

Select One:

Formal Quote (RI Letterhead & Signature)

Informal Quote (ballpark estimate of services)

Project Description:
(Please provide a high-level description of your project and aims, and a high-level overview of the project specific requirements)

* must provide value

Expand

Please provide a brief description of the work to be completed by the RDS team in lay terms. Include any relevant information on data that RDS will receive from the study team and data RDS will share with third parties, if applicable.

* must provide value

Expand

Upon completion of the project; what is your expectation for product delivery: (Check all that apply.)

Custom Data Set

Registry Creation

Natural language processing algorithms

Recruitment or Chart Review list (ONLY includes the following variables: MRN, DOB, race, and gender)

Patient Recruitment List - Other

Software

Patient Linkage/Matching

PPRL

Other

If other, please tell us what you envision.

Expand

Do you have any documents you would like to attach to explain your request in more detail? (Examples: Specific aims, variable lists, etc.)

Please attachment your document here

Please attachment your document here

Please attachment your document here

Please attachment your document here

Please attachment your document here

Is there a date/deadline by which you need to receive the results of your feasibility request? Please note that we may not be able to accommodate all deadline requests.

* must provide value

M-D-Y

If this data will be submitted as part of a grant proposal or other request for funding, please provide the planned submission date.

M-D-Y

How is the requested feasibility data being used?

* must provide value

How is this information being used? Other - please describe

* must provide value

What type of Biobank request is this?

Banked

Prospective

Which institutions should we query for your feasibility request? (select one or more)

* must provide value

Eskenazi Health

IU Health

All INPC

Specific institutions not listed above (opens text box)

Which other institutions should we query for you? (provide list)

* must provide value

What types of aggregate counts are you requesting? Please also describe any related summary counts that would be helpful. Provide as much detail as possible, including specific ICD 9/10 codes, care settings, and date ranges whenever possible. (Alternatively, attach a document below that outlines the counts needed.)

PLEASE NOTE: the analyst assigned to your request will be unable to begin work without this information.
Examples:
1. "We need to know the number of individuals who were seen in the ER for eye trauma between 2020 and 2023; we will provide ICD codes for eye trauma."
2. "Please provide a count of IUH patients 2019-2021 who had an ICD-9/ICD-10 code for relapsed multiple myeloma (203.02, 203.12, 203.82; C90.02, C90.12, C90.22). We are also requesting a count of how many of these patients have one or more clinical notes available in the year after that diagnosis."

* must provide value

Expand

Feasibility Cohort Inclusion Criteria:

Please use LT for "< ", LTE for "<=", GT for ">" and GTE for ">=" as these symbols cause errors in the ticketing system.

Example: all female patients with a visit with an ICD-9 code of 780.3x and/or 345.x whose age is GT 50 and LTE 75.

For assistance identifying codes and terms, we suggest the following resources:

ATHENA (OHDSI): https://athena.ohdsi.org/search-terms/start
- Search by key term to identify matches across multiple vocabularies
LOINC: https://loinc.org/
- Extensive resources on the LOINC standard, including guides and a searchable database
ICD-10 code lookup: https://icd10cmtool.cdc.gov/
ICD-9/ICD-10 code converter from AAPC

* must provide value

Expand

Feasibility Cohort Exclusion Criteria:

* must provide value

Expand

Feasibility Cohort Size (if known):

Feasibility data capture date range (MM/DD/YYYY to MM/DD/YYYY):

Start Date

End Date

* must provide values

Is there any other information we should know regarding this feasibility request? (e.g., urgent deadline)

1. Feasibility Cohort Definition

Define the index period for your cohort. This is the date range in which the inclusion criteria are met. Please note that the earliest start date possible for these requests is 1/1/2015.
Example: patients who had a diagnosis between January 1, 2021, and December 31, 2022.

Index period start:

Index period end:

* must provide values

Define the follow-up period for your feasibility cohort. This is the period of time for which data are pulled for the patients meeting your inclusion criteria.

Example: for the above cohort, please pull data from January 1, 2020, through December 31, 2023.

Follow-up period start:

Follow-up period end:

* must provide values

Enter any additional descriptions for your index and follow-up date ranges

Expand

Feasibility Cohort INCLUSION Criteria

For assistance identifying codes and terms, we suggest the following resources:

ATHENA (OHDSI): https://athena.ohdsi.org/search-terms/start
- Search by key term to identify matches across multiple vocabularies
LOINC: https://loinc.org/
- Extensive resources on the LOINC standard, including guides and a searchable database
ICD-10 code lookup: https://icd10cmtool.cdc.gov/
ICD-9/ICD-10 code converter from AAPC

Category	INCLUSION Criteria, Items of Interest, and Threshold Values
Diagnoses (include ICD-10 codes or SNOMED codes; e.g. "patients with at least one AMI diagnosis (ICD 10 121.*))
Medications (include RxNorm ingredients or CVX code; e.g., "patients with at least 3 records of heparin (rxnorm 5224)")
Labs (include LOINC codes; e.g., "patients with at least 1 cardiac troponin test (LOINC code 10839-9)")
Encounter (hospitalization, outpatient visit, ED; e.g., "patients with at least 1 ED visit")
Demographics (age, sex, race, ethnicity, most recent zip; e.g., "patients ages 65 or over")
Vitals (height, weight, bmi, bp, temperature; e.g., "patients with at least 4 recorded bp measurements")

Feasibility Cohort EXCLUSION Criteria

Category	EXCLUSION Criteria, Items of Interest, and Threshold Values
Diagnoses (include ICD-10 codes or SNOMED codes)
Medications (include RxNorm ingredients or CVX code)
Labs (include LOINC codes)
Encounter (hospitalization, outpatient visit, ED)
Demographics (age, sex, race, ethnicity, most recent zip)
Vitals (height, weight, bmi, bp, temperature)

Other inclusion/exclusion criteria not described above, including criteria that describe both exclusion and inclusion:

Note: lists of codes/criteria of interest may also be attached in the "Additional Information & Attachments" section above.

Expand

2. Requested Assessments/Counts

Below are examples of available summary counts; please choose from the provided list and/or specify your desired summary counts.

For a Rapid Data feasibility request, you may select up to three options.

* must provide value

Total count of individuals meeting cohort inclusion/exclusion criteria

Demographic summary (age, sex, race, ethnicity) of this count

Median and interquartile range for numbers of encounters (inpatient, outpatient, ED)

Top 10 diagnosis codes, medications, and/or labs represented (including percentage of cohort with each)

Counts of patients at each inclusion/exclusion step

Other - please specify below

What other feasibility assessments/aggregate counts are you requesting?

Expand

Please select the best description for your study/request:

Please note: A recruitment or chart review list may ONLY contain the variables MRN, DOB, race, and gender. If you require more data points in your request, please select one of the recruitment options, or data extraction.

* must provide value

Recruitment for interventional study

Recruitment for observational study

Recruitment or chart review list (ONLY includes variables MRN, DOB, race, and gender. Fully identified data.

Data extraction

Other

Data elements needed:
Either data elements (e.g. Medications, Encounters, Diagnoses, procedures, demographics, Labs, Orders, SDOH, Location-based data, Indices (such as Charlson, Elixhauser, Social Vulnerability, etc.) or specific variables (e.g., age, race, diagnosis, service area, PCP, etc.) may be listed.

NOTE: If your project has a HIPAA waiver and you are requesting PHI, each PHI variable must be listed in your IRB protocol submission.

* must provide value

Expand

Does your project require a dataset or other deliverable only, or does it also require consultation with an analyst/engineer?
Consultation includes having an analyst/engineer available during regular meetings, the design phase, and/or any other commitments/communications outside of those needed to provide one or more project deliverables.

Deliverables only

Deliverables AND consultation

Unsure/Request to discuss

Do you anticipate having RDS staff attend regular team meetings through the duration of the project?

Yes

No

If so, what is the anticipated frequency and lengths of these meetings?

Is this a new proposal or continuation of an existing project?

New

Continuation

What is the current funding status for this project?

Granted/Funded

Applied For

Pending

Will Apply

Funding Source/Grant Name

(e.g. NIH grant name/ID, RFA/FOA/RI Internal/External numbers)

* must provide value

Expand

What is the funding source type?

* must provide value

Federal/State

Non-Federal

Department/Discretionary

Commercial /Industry

Other

Briefly describe the "Other" type of funding source

* must provide value

If industry-sponsored, will the funding be coming directly from the industry sponsor or will it be flowing through another entity?

Directly

Flow through

Is this part of a larger proposal being submitted by Regenstrief?

Yes

No

Is there a cap, maximum cost, or other budget constraint for the proposed work by RDS on this project?

* must provide value

Yes

No

Please briefly describe the budget constraints for the proposed work

* must provide value

Is this a multi-year project?

Yes

No

Budget Start Date
Budget End Date

If these details are not yet available, please provide us with your best estimate, or enter 9/9/1999.

Is the time frame during which RDS is needed different than the project period specified on the award/budget?

Yes

No

Unknown at this time

Expected Regenstrief Data Services timeline. This may differ from the project timeline.

Expected Regenstrief Data Services Start Date
Expected Regenstrief Data Services End Date

If these details are not yet available, please provide us with your best estimate, or enter 9/9/1999

* must provide values.

Is there a hard deadline by which you will need to receive the requested data?

* must provide value

Yes

No

Deadline

* must provide value

M-D-Y

Please provide a brief explanation for the deadline.
If this project involves multiple deadlines, please provide the relevant details below.

Expand

1. Cohort Definition

Define the index period for your cohort. This is the date range in which the inclusion criteria are met. Please note that the earliest start date possible for these requests is 1/1/2015.
Example: patients who had a diagnosis between January 1, 2021, and December 31, 2022.

Index period start:

Index period end:

* must provide values

Define the follow-up period for your cohort. This is the period of time for which data are pulled for the patients meeting your inclusion criteria.

Example: for the above cohort, please pull data from January 1, 2020, through December 31, 2023.

Follow-up period start:

Follow-up period end:

* must provide values

Enter any additional descriptions for your index and follow-up date ranges

Expand

Cohort INCLUSION Criteria

For assistance identifying codes and terms, we suggest the following resources:

ATHENA (OHDSI): https://athena.ohdsi.org/search-terms/start
- Search by key term to identify matches across multiple vocabularies
LOINC: https://loinc.org/
- Extensive resources on the LOINC standard, including guides and a searchable database
ICD-10 code lookup: https://icd10cmtool.cdc.gov/
ICD-9/ICD-10 code converter from AAPC

Category	INCLUSION Criteria, Items of Interest, and Threshold Values
Diagnoses (include ICD-10 codes or SNOMED codes; e.g. "patients with at least one AMI diagnosis (ICD 10 121.*))
Medications (include RxNorm ingredients or CVX code; e.g., "patients with at least 3 records of heparin (rxnorm 5224)")
Labs (include LOINC codes; e.g., "patients with at least 1 cardiac troponin test (LOINC code 10839-9)")
Encounter (hospitalization, outpatient visit, ED; e.g., "patients with at least 1 ED visit")
Demographics (age, sex, race, ethnicity, most recent zip; e.g., "patients ages 65 or over")
Vitals (height, weight, bmi, bp, temperature; e.g., "patients with at least 4 recorded bp measurements")

Cohort EXCLUSION Criteria

Category	EXCLUSION Criteria, Items of Interest, and Threshold Values
Diagnoses (include ICD-10 codes or SNOMED codes)
Medications (include RxNorm ingredients or CVX code)
Labs (include LOINC codes)
Encounter (hospitalization, outpatient visit, ED)
Demographics (age, sex, race, ethnicity, most recent zip)
Vitals (height, weight, bmi, bp, temperature)

Other inclusion/exclusion criteria not described above, including criteria that describe both exclusion and inclusion:

Note: lists of codes/criteria of interest may also be attached in the "Additional Information & Attachments" section above.

Expand

2. Requested Data Elements

Below are commonly requested variables available in the OMOP-formatted INPC that are available for patient-level datasets; please choose from the provided list and/or specify other variables of interest (recognizing they may not be available in the OMOP format).

Category	Include	Specify variables/elements to include
Dx (all, or include specific ICD-10 codes or SNOMED codes)
Medications (all, or meds of interest)
Labs (all, or labs of interest)
Encounters (hospitalization, outpatient visit, ED)
Demographics (age, sex, race, ethnicity, most recent zip)
Vitals (height, weight, BMI, BP, temperature)
Other - please specify

The RDS INPC OMOP data is stored as a Limited Data Set and will be provided at that security level. Your IRB protocol must allow for the receipt of a Limited Data Set.

What type of data do you plan to request?

De-identified data may contain offset dates or year, no geography smaller than US state.

Limited data allows real dates and geographic levels city, state and zip code.

Identified data may contain protected health information (e.g. MRNs, names, DOB, address).

Not sure? Contact AskRDS@regenstrief.org and we will be happy to help you determine which data type best fits your research needs.

* must provide value

Deidentified Data Set

Limited Data Set

Protected Health Information (e-PHI)/Fully Identified Data Set/Fully Identifiable Data Set (includes de-identified and limited data sets that will be re-identified by the study team on receipt)

Not Sure

Does the project require:

a single deliverable (such as a one-time data pull or recruitment list, with or without refreshes),
OR multiple deliverables over time

Single deliverable, one-time data pull

Single deliverable with refreshes (see below)

Multiple deliverables over time

Other

Please describe the type(s) of deliverable(s) your project requires and their frequency

Does the data need to be refreshed?

Yes

No

Does your project require a one-time recruitment or chart review list ONLY?

NOTE: A recruitment or chart review list may ONLY contain the variables MRN, DOB, race, and gender.

* must provide value

Yes

No

Unsure

What will be the frequency of the refreshes?

If Other, please specify frequency:

Expand

Data Sources:
Note: any data sources indicated here must also appear as data sources in the IRB protocol for the project.

* must provide value

Eskenazi EPIC EDW

INPC

INPC OMOP (a version of the INPC data in the specific OMOP Common Data Model)

IUH EDW

Other

Not Applicable

If Other, please list data sources:

If existing studies will be used as data sources for this project, include the IU IRB number for those projects here.

Expand

Are you requesting IU Health data only?

* must provide value

Yes

No

Do you need real-time IU Health data?
("Real time" refers to a continuous feed of data, and does not include recruitment lists.)

* must provide value

Yes

No

Note: IU Health fulfills all requests for real-time data. By selecting this option, your request will be forwarded directly to IU Health.

Do you need IU Health billing data?
(Refers to billing/cost data. Does not include using ICD codes to identify or supplement patient cohorts.)

* must provide value

Yes

No

Note: IU Health fulfills all requests for billing data. By selecting this option, your request will be forwarded directly to IU Health.

Are you recruiting from IU Health?

* must provide value

Yes

No

Is anyone on the study team employed as a clinician at IU Health?

* must provide value

Yes

No

Please provide the name of the IU Health clinician.

* must provide value

In order to obtain IU Health data for recruitment purposes, a person authorized to recruit for IU Health will need to be a member of the study team. To be connected with someone who can fulfill this role, please contact Brenda Hudson, Indiana Clinical and Translational Sciences Recruitment Concierge Director at brlhudso@iu.edu.

Cohort Inclusion Criteria:

Please use LT for "< ", LTE for "<=", GT for ">" and GTE for ">=" as these symbols cause errors in the ticketing system.

Example: all female patients with a visit with an ICD-9 code of 780.3x and/or 345.x whose age is GT 50 and LTE 75.

For assistance identifying codes and terms, we suggest the following resources:

ATHENA (OHDSI): https://athena.ohdsi.org/search-terms/start
- Search by key term to identify matches across multiple vocabularies
LOINC: https://loinc.org/
- Extensive resources on the LOINC standard, including guides and a searchable database
ICD-10 code lookup: https://icd10cmtool.cdc.gov/
ICD-9/ICD-10 code converter from AAPC

Expand

Cohort Exclusion Criteria:

Please use LT for "< ", LTE for "<=", GT for ">" and GTE for ">=" as these symbols cause errors in the ticketing system.

Example: all female patients with a visit with an ICD-9 code of 780.3x and/or 345.x whose age is GT 50 and LTE 75.

Expand

Cohort Size (if known):

Data capture date range (MM/DD/YYYY to MM/DD/YYYY):

Start date

End date

Does your project require either free text notes or the extraction of data from free-text notes?

Free text notes

Extraction of data from free-text notes (by RDS)

Both

Neither

Will this project require the use of CPT codes? This includes requests in which CPT codes are a requested data element.

Please note: our data analysts do not have direct access to CPT codes. Our analysts can request CPT codes from IU Health, with a minimum two-week turnaround time required. CPT codes are not reliably available in INPC or from other institutions.

* must provide value

Yes

No

Will your project require the effort of Regenstrief chart reviewers?

Yes

No

Will your project require any of the following: use of cloud services (AWS, Azure, GCP), FISMA compliance, or similar?

* must provide value

Yes

No

Please briefly summarize your requirements for cloud services, FISMA compliance, or similar functions

* must provide value

Expand

Does this study involve the use of AI or LLM?

* must provide value

Yes

No

Will this study involve the use of AI or LLM with healthcare data/data covered by HIPAA obtained from Regenstrief Data Services?

* must provide value

Yes

No

Will this study specifically use GenAI or LLM?

GenAI (Generative AI) is a specialized subset of AI tools which are focused on creating original content based on training data. Content may include text, images, code, and beyond.

* must provide value

Yes

No

Who is the sponsor for this project?

* must provide value

Will data be shared with the sponsor?

* must provide value

Yes

No

Please select the best descriptor for the GenAI/LLM tools to be used in this project

* must provide value

Local/On-premise LLM

Institution-managed private cloud LLMs

Commercial LLM API

Other

Please describe the other type of GenAI/LLM used in this project

* must provide value

Is an AI model or software an planned outcome for this project?

* must provide value

Yes

No

What is the lifecycle stage of the proposed AI model or software product?

* must provide value

Please provide a brief explanation of the use of AI and/or LLM in this project.

Include the following in your response:

The source/vendor of the AI/LLM tools to be used.
A description of the data to be used with the AI/LLM tools, including the source and whether the data to be used is healthcare data/covered by HIPAA. If healthcare data will be used, include the data level (fully identified/PHI, limited, deidentified).
Any other details related to data flow, sharing, and specifics of the AI/LLM tool to be used.

* must provide value

Expand

Will you be using REDCap to store any of the data received from RDS?

Yes

No

Unsure

Who will build your REDCap project?
Please note that if you request that RDS builds your REDCap project, we will include this cost in your estimate. If you are unsure at this time, you can opt to request that RDS build your REDCap at a later time, and we will provide a revised estimate and instructions then.

Regenstrief Data Services (please include this cost in the requested estimate)

Study team, investigator, or other service provided by investigator's institution

Other

Unsure at this time

Please briefly describe who will build your REDCap project.

If specific software will be required for your project, please name the software required here.

Where do you plan to store the data?

Please note: data will need to be stored in an approved location, and this location will be listed on data agreements for identified and limited data.

Common approved locations include:

Secure Microsoft Teams when appropriately requested with the Institutional Storage Request Form,
IU REDCap,
Slate-Project on HPC (Slate),
Secure Folder on Regenstrief file server OR IU Department of Biostatistics file server.

Please let us know if you need assistance with this decision.

* must provide value

Where specifically will you be storing the data?

Will the project include a 3rd party vendor?

Yes

No

Not Sure

Is there an outside company/commercial entity involved in your project? For the purposes of this question, "involved" includes any sharing of data, IP, code, and any similar products.

Yes

No

Will the data provided by RDS be shared with any entities external to IU or Regenstrief?

* must provide value

Yes

No

Please provide the name of the company/commercial entity involved in this project.

If more than one organization external to Regenstrief Institute or IU is involved, please list the names of each organization with a brief statement of what will be shared with each.

* must provide value

What are you sharing?

Please briefly describe any data, code, IP, etc. that will be shared externally, and the mechanism for sharing. If multiple organizations are involved, please describe what each organization will receive.

Expand

Who owns the IP coming out of this project?

Does the sponsor own the data after delivery?

Yes

No

Please submit sponsor contract with rest of the documentation.

Please submit sponsor contract with rest of the documentation.

Who (name, company) will receive the data requested for this project?

Hidden per Chris Harle 11/20/2025

Is there any other information we should know regarding this request?

Expand

Do you have IU IRB approval?

* must provide value

Yes-submitted and approved

Yes-submitted and pending

No-I plan to submit

No-not applicable

Briefly explain why IRB approval is not applicable to your request

* must provide value

IU IRB protocol number

Date of submission

M-D-Y

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