ࡱ> BDA} bjbj55 $__J 81,]$E'3"UUUD\@0&&&&&&&=(*p&9pDDpp&UU&pUU&p&V%@`&U;CR% &'0E'%xO+4O+`&O+`&Pppppppp&&pppE'ppppO+ppppppppp : Missouri Department of Health and Senior Services REQUEST FOR REVIEW OF RESEARCH PROTOCOL ABSTRACT OF PROTOCOL Purpose  FORMTEXT       How will the research data be collected? (Questionnaires, interviews, collection of tissue or body fluids, review of existing records, data, etc.) Indicate if researchers will have contact with subjects.  FORMTEXT       Hypothesis and variables to be investigated  FORMTEXT       What are the potential risks to the subjects and benefits to subjects and/or society?  FORMTEXT       How will anonymity OR confidentiality be assured?  FORMTEXT       Will informed consent be sought from all subjects and documented in writing?  FORMCHECKBOX  YES (  FORMCHECKBOX  NO If yes, a copy of the conbd      ǺiZǺDiZ+jvh~>*CJOJQJU\^Jhj>*CJOJQJ\^J0jha>*CJOJQJU\^JmHnHu+jh~>*CJOJQJU\^Jha>*CJOJQJ\^J%jh~>*CJOJQJU\^JhjCJOJQJ\^JhaCJOJQJ\^Jhj5CJOJQJ\^Jha5CJOJQJ\^Jhahj haCJd   < d f  h^h & F vv^v`gda  h^h & F v^`gda$ vt82^2`a$ : < > R T V ` b d h    * , . 8 : < @ íҔ҅oҔ҅YҔRM hj5 hj5>*+jh~>*CJOJQJU\^J+jbh~>*CJOJQJU\^Jhj>*CJOJQJ\^J0jha>*CJOJQJU\^JmHnHu+jh~>*CJOJQJU\^Jha>*CJOJQJ\^J%jh~>*CJOJQJU\^JhjCJOJQJ\^JhaCJOJQJ\^Jf h  < > @ p pr| ^  p^ & F vh^hgda & F v^`gda h^h & F vv^v`gda  n p r nr  (*,26m(jh~CJOJQJU\^J(j6h~CJOJQJU\^JU(jh~CJOJQJU\^J jhaCJOJQJ\^J(jNh~CJOJQJU\^J"jh~CJOJQJU\^JhjCJOJQJ\^JhaCJOJQJ\^J#sent form must be included with application for review. Is informed consent waiver or alteration requested?  FORMCHECKBOX  YES (  FORMCHECKBOX  NO If requesting a waiver or alteration of informed consent requirements, what are the reasons?  FORMTEXT       If requesting exemption, explain which category of exemption applies (see 45 CFR 46.101 (b)).  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