READi Project Intake Form

Questions? E-mail us at readinavigators@unmc.edu.


DO NOT ENTER ANY PHI INTO THIS FORM - INCLUDING MRN's

 

*A Qualified investigator is a UNMC Faculty Member or a staff member of the Health System from which data is being requested.

 

*A Qualified investigator is a UNMC Faculty Member or a staff member of the Health System from which data is being requested.

 
 

This email address will be the designated contact for our team, expect future correspondence to be exchanged with this address.


If your email does not appear in the list please manually enter it.

 

This should be the Qualified Investigator's academic affiliation. This can be found in the University of Nebraska's Address Book.

 

e.g. A Project Coordinator, student/fellow on project, etc.


Please note that automated status update emails will be sent to the contacts listed below as well as the Qualified Investigator's email address.

 
 

Project Information

 
 
 
 
 
 

Data Sources

 

Select all that apply.

 

*Funding of any type including departmental funding.

 
 
 

UPLOAD FILE(S) HERE:


 

DO NOT UPLOAD ANY PHI - INCLUDING MRN's

1) The central site IRB protocol (if using a central IRB other than UNMC).


2) If this project is a QI Project and/or not human subjects research, the letter from the IRB must be uploaded below.

Get IRB Letter Here


3) If requesting Community Connect data, upload proof of permission from the Community Connect Site.


4) An excel spreadsheet with columns labeled with the variable names you would like in your report. (This is optional but helps us make sure what we build matches what you expect to receive).

Drop your files here