Mercy: Excellence. Every Day in Every Way.

ADVANCED SEARCH

  • For Patients
  • For Visitors
  • Mercy Services
  • Health Questions?
  • Higher Education
  • For Physicians

Initiating the Clinical Trial Application

Initiating the Clinical Trial Application  |   Application Form and Guidelines  |   Conflict of Interest & Financial Disclosure  |   IRB Oral Presentation Guidelines  |   Application FAQs


To review a new study, the IRB needs the following:


  • A fully completed clinical trial application meeting Mercy Medical Center guidelines.
  • A Patient Informed Consent Form revised to meet the standards of Mercy Medical Center.
  • Protocol or Study Design.
  • Investigators Drug Brochure or Instructions For Use Brochure.
  • A completed (signed and dated) Financial Disclosure for every investigator listed on the application.
  • A completed CV (signed and dated) for every investigator listed on the application (only needs to be submitted one time a calendar year.)
  • A completed Billing and Allocation of Costs Guide.
  • A completed Study Sponsor Information Sheet.
  • Any other materials that would be used for patient incentive programs, patient education, or media advertising.

This paperwork is required to be completed and submitted with an original date and signature. If any of the documents are not completed or parts are missing, your study will not be placed on the agenda.

You can send the above items through interoffice mail to: Dee Burns – Medical Staff Office. If you need help in completing any of the forms, please contact Dee at (515) 247-3985.




* PDF documents require Adobe Reader.


QUICK INFO

Mercy Institutional Review Board
c/o Medical Staff Office
Attn: Marsha White – IRB Coordinator

1111 6th Avenue
Des Moines, IA 50314

Phone: (515) 247-3985
Fax: (515) 643-8986

Email: mwhite3@mercydesmoines.org


Matthew Andres, D.O.
Chairman, Mercy IRB
1111 6th Avenue
Des Moines, IA 50314
Phone: (515) 247-3985
Fax: (515) 643-8986