Transcript of "Quorum Review Institutional Start Up Package"
Institutional Start-Up Package Table of Contents1. Welcome Letter from Quorum Review’s Director of Client Relations & Marketing, Arri Burgess2. Setting Up a Relationship with Quorum Review IRB3. Agreement for Services Between Quorum Review and [Institution]4. Sample Hospital or Institution Cover Page5. Guide to Consent Form Development6. Umbrella Institutional Authorization Agreement7. Quorum Institutional Authorization Agreement Form
Dear Colleague:Patient protection in clinical trials is taking center stage in our industry, while at the same time,organizations are being asked to do more with less. IRBs within institutions are looking for waysthat they can expand their current capacity and improve their review cycle timelines withoutincreasing costs. Some institutions are looking for secondary supplier alternatives while othersare looking to focus on research and outsource the IRB function all together.Quorum Review IRB can help. Quorum Review is an AAHRPP accredited independent ethicsreview board that offers customized processes for the ethics review of institutional research.Funding agencies and study sponsors are placing increasing emphasis on ethics review by anaccredited board. Thought leaders recognize that independent review boards can provide high-quality oversight. The time has never been better to shift some or all of your institution’sreviews to an independent ethics review board. Many institutions already outsource the reviewof studies regulated by the Food and Drug Administration, and the Office of Human ResearchProtections is contemplating legislation that would further encourage institutions to shift reviewfunctions to outside ethics review organizations.And in a world in which budgets are shrinking, Quorum Review offers the efficiencies andreliability of one of the largest ethics review organizations in the nation.Enclosed is our Institutional Start-Up Package. The goal of this package is to make it easy foryou and your institution to establish a relationship with Quorum Review. Once the relationshipis established, we can work with your institution when you are ready - on a study-by-study basisor more globally. Within this packet you will find a template contract, a guide to developingconsent forms, and an example of a customized cover pages for site submissions.Please feel free to contact me if you have any additional questions or would like me to contactanother individual within your organization to move the process along. Quorum is committed toour relationships with institutions.Warm Regards,Arri BurgessDirector of Client Relations and Marketingbusdev@quorumreview.com206-448-4082
SETTING UP A RELATIONSHIP WITH QUORUM REVIEW IRBThere are several different steps that can occur when an institution establishes a working relationship with QuorumReview IRB. A menu of options is below as well as a description of each option. Should you require further assistanceplease contact Business Development, 206-448-4082 or email@example.com.Options for establishing a working relationship 1. Confidentiality/Disclosure Agreement - Protects the exchange of confidential information. 2. Institutional Authorization Agreement (IAA) – A brief agreement to establish the relationship between Quorum Review and the institution on a study-by-study basis. 3. Master Services Agreement (MSA) – A more extensive version of the IAA to better define the terms of the relationship, including the deliverables to the institution, communications between the institution and Quorum, definitions of unique requirements, and establishing how the institution and Quorum will identify those studies subject to the agreement. 4. “Locked In” consent form language – Upon request, the Quorum Review IRB will review proposed template sections of a consent form and provide pre-approval for that language to be used. 5. Training of institutional staff – Quorum Review can train, at no charge, the institution’s clinical staff on how best to work with Quorum. 6. Site Visit of Institution – Quorum Review prefers to conduct regular site visits of institutions. 7. Site Visit of Quorum Review – Quorum Review invites institutions to visit our office in downtown Seattle.Explanations of options1. Confidentiality/Disclosure AgreementPurpose:This short contract serves as a legal means of compelling both sides to respect the confidentiality of our relationships.Tools provided:Quorum has provided in this package a template CDA. Feel free to propose revisions or propose use of yourorganization’s template.Where to send the completed information:Please submit to Business Development by email at firstname.lastname@example.org. The document will be routed toQuorum’s contract group for approval.2. Institutional Authorization AgreementPurpose:An institutional authorization agreement (IAA) spells out the relationship between the institution’s IRB and QuorumReview IRB. Quorum accepts on a study-by-study basis the template IRB/IEC Authorization Agreement posted by theOffice of Human Research Protection (OHRP) at http://www.hhs.gov/ohrp/assurances/. Alternatively, you can useQuorum’s partially pre-populated version of the IAA (enclosed).Tools provided:Quorum has provided in this package a partially pre-populated IAA. Feel free to propose revisions or propose use ofyour organization’s template.
Where to send the completed information:Please submit to Business Development by email at email@example.com. The document will be routed toQuorum’s contract group for approval.3. Master Services AgreementPurpose:A Master Services Agreement (MSA) spells out the terms of the working relationship with Quorum Review IRB in moredetail than an IAA and can apply to all studies submitted to Quorum. The following items can be addressed in the MSA: Template consent form language to be pre-approved by the Board; How institution researchers will submit to Quorum Review; Any unique requirements of the institution.Tools provided:Quorum has provided in this package a template MSA. Feel free to propose revisions or propose use of yourorganization’s template.Where to send the completed information:Please submit to Business Development by email at firstname.lastname@example.org The document will be routed toQuorum’s contract group for approval.4. “Locked In” Consent Form LanguagePurpose:The consent form negotiation part of study start up can get very complicated. In order to streamline this process, theQuorum Review IRB can review and pre-approve sections of a template consent form prior to receiving a submissionfrom the institution. This is especially helpful for institution-specific HIPAA language, emergency contact information, etc.Establishing this process prior to submission greatly alleviates many of the headaches of this process.Tools provided:When you submit a draft MSA to Quorum Review, please include a generic consent form containing all the requiredelements for your institution. If you need assistance drafting your consent form language, Quorum has a variety oftemplates available as well as guidance to consent form development. Please contact Customer Relations at 206-448-4082 or CustomerRelations@quorumreview.com.Where to send the completed information:Once your template consent form is complete please submit to Business Development at email@example.com. Training of Institution StaffQuorum understands that there is a learning curve with utilizing a new service. To that end, we are willing to providetraining webinars at your convenience – or we could arrange a visit to your institution. If interested, please send an emailto Business Development at firstname.lastname@example.org. Site Visit of InstitutionQuorum Review prefers to conduct site visits of institutions. A site visit probably will be requested within a year of signingan MSA.7. Site Visit of Quorum ReviewQuorum Review is located in the heart of downtown Seattle. We invite you to visit Quorum to get to know us better, meetour Board members and become comfortable with our policies and procedures.
1601 Fifth Ave. Suite 1000 Seattle, WA 98101 MASTER SERVICE AGREEMENT BETWEEN QUORUM REVIEW AND [INSTITUTION]THIS AGREEMENT FOR SERVICES (“Agreement”), effective __________ (the “Effective Date”), is made byand between Quorum Review, Inc., a Washington corporation with its principal place of business at 1601 FifthAvenue, Suite 1000, Seattle, Washington 98101, (hereinafter “Quorum”), and [Institution] a [state] corporation,with its principal place of business at _____ (hereinafter “Institution”).WITNESSETHWHEREAS, Institution desires to obtain institutional review board (IRB) oversight services for certain researchstudies involving non-exempt human subjects research; andWHEREAS, Quorum is willing to provide such services upon the terms and conditions set forth herein;NOW THEREFORE, the parties do agree as follows:1. QUORUM’S RESPONSIBILITIES A. New Research Studies. Quorum agrees to assume IRB oversight responsibility and to perform IRB functions in compliance with applicable federal and state regulations for certain new research studies involving human subject research to be conducted at Institution. Quorum’s services shall include, but not be limited to: review and approval or disapproval of new protocols; review and approval, disapproval or modification of consent forms; review and approval or disapproval of the investigator(s); collection of reports of unanticipated problems; and maintenance of required IRB records pursuant to 21 CFR § 56.115 and 45 CFR § 46.115. Quorum shall conduct continuing review of certain new research studies appropriate to the degree of risk in such studies. Quorum agrees to conduct at least an annual review of each study. B. Quorum’s Primary Duty. As set forth in 21 CFR § 56.102(g) and 45 CFR §§ 46.102(g), 46.109 and 46.111, Quorum’s primary duty is to protect the rights and welfare of “human subjects,” a term defined by 21 CFR § 56.102(e) and 45 CFR §46.102(f). Nothing in this Agreement will be construed to limit Quorum’s independence to take actions necessary to protect the rights and welfare of human subjects, or to alter Quorum’s primary duty to human subjects. C. Compliance with Applicable Laws and Regulations. Quorum shall perform the services hereunder in compliance with applicable federal and state laws and regulations governing IRBs and research with human beings, including the United States Food and Drug Administration (“FDA”) Regulations 21 CFR Parts 50 and 56 and the United States Department of Health and Human Services (“DHHS”) Regulations 45 CFR Part 46. D. Notification Requirements. Quorum will promptly notify Institution of any (i) unanticipated problems involving risks to subjects or others, (ii) serious or continuing noncompliance with pertinent Regulations or Board determinations, (iii) suspension or termination of Board’s approval of the Study or (iv) other issues as requested by Institution. Relevant minutes of Board meetings may be made available to Institution by Quorum upon request.F-135-001, Institutional Master Service Agreement, 18Jun2012 Page 1 of 6
1601 Fifth Ave. Suite 1000 Seattle, WA 98101 E. Insurance. Quorum will provide at its expense, and maintain throughout the term of this Agreement, professional liability coverage in an amount no less than $1,000,000 each claim/$3,000,000 annual aggregate; general liability coverage in an amount no less than $1,000,000 each claim/$3,000,000 annual aggregate, and officer and director liability coverage in an amount no less than $1,000,000 each claim/$3,000,000 annual aggregate. Upon request, Quorum agrees to provide Institution with Certificates of Insurance demonstrating this coverage.2. RESPONSIBILITIES OF INSTITUTION A. General. Institution agrees that Quorum shall be one of its IRBs of record. Institution agrees to facilitate Quorum access to Institution expertise when needed for IRB review. In keeping with the requirements of 21 CFR § 56.112, Institution cannot approve any research study that has been disapproved by Quorum. Institution may, however, disapprove any study approved by Quorum. Institution agrees to abide by the decisions of Quorum and shall use its best efforts to ensure that the clinical research performed by Institution shall be conducted in accordance with those decisions. B. Investigators and Staff. Institution shall ensure that the investigators and other staff at Institution who are conducting studies under Quorum review are appropriately qualified and meet Institution’s standards for eligibility to conduct research. Institution shall ensure that investigators conducting research at Institution receive proper initial and continuing education on the requirements related to human subject protection. C. Review of Clinical Trial Agreements (CTA). Institution shall ensure that the Clinical Trials Agreement (CTA), if any, and the approved consent form do not conflict with each other regarding the compensation for injury. Institution will inform Quorum of its procedures to resolve such conflicts upon request. In the event of a conflict between the CTA and the consent form, the research will not commence until the conflict is resolved in a way acceptable to Institution and Quorum. D. Notification Requirements. Institution agrees to notify Quorum of all communications to and from the FDA, OHRP and/or other applicable federal and state regulatory agencies regarding the studies that have been referred to Quorum. Institution also agrees to notify Quorum of any related IRB matters concerning investigators who have submitted studies to Quorum for review. E. Research Submission Requirements. Institution will notify Quorum of any research requiring Quorum’s review, and will follow Quorum’s standard submission requirements to initiate the review process and/or transfer studies to Quorum. Each Study shall be submitted to Quorum with an accompanying “Institution Cover Page” in substantially the form as set forth in Exhibit A, attached hereto and incorporated herein by reference. Also, an Institutional Waiver Form shall be submitted for each Study with the box indicating the existence of this Agreement marked appropriately (form available from http://www.quorumreview.com). F. Insurance. Institution will provide at its expense, and maintain throughout the term of this Agreement, comprehensive professional, general, and officer and director liability coverage in amounts no less than specified in Section 1(E) of this Agreement. Upon request, Institution agrees to provide Quorum with Certificates of Insurance demonstrating this coverageF-135-001, Institutional Master Service Agreement, 18Jun2012 Page 2 of 6
1601 Fifth Ave. Suite 1000 Seattle, WA 981013. CONFIDENTIALITY A. Definitions. For purposes of this Agreement, the party that transmits Information shall be referred to as the “Discloser,” and the party to which Information is transmitted shall be referred to as the “Recipient.” The term “Confidential Information” shall mean any and all information disclosed by the Discloser to the Recipient, or to any of its agents, affiliates, officers, directors, employees and subcontractors either in oral, written or any tangible form. Confidential Information includes, but is not limited to, technical, scientific, financial, strategic, marketing or product information; practices and processes; business systems and techniques; billing practices; computer processes, programs and codes; forms; and production processes. B. Non-Disclosure and Non-Use. Recipient shall hold in confidence any and all Confidential Information revealed by the Discloser or with which it became acquainted within the framework of this Agreement, and shall not use or disclose Confidential Information to any person or entity, except (i) to such of its own employees, independent contractors and representatives in the course of providing services hereunder (ii) to authorized agents of the federal government if required for audit or regulatory purposes, and (iii) to such other recipients as the Discloser may give prior written approval; provided, however, that recipients of Confidential Information shall have first executed a confidentiality and non- use agreement with the Recipient. Each party further agrees that Confidential Information shall not be used except for the purpose of this Agreement as set forth herein. Notwithstanding the foregoing, nothing in this Agreement shall be construed to restrict a party from disclosing Confidential Information as required by law, subpoena, court order, or other governmental order or request. Additionally, nothing in this Agreement shall restrict a party from disclosing that Quorum reviews research for the Institution. C. Exceptions. The obligations of this Section 4 will not apply to any Confidential Information which the Recipient is able to demonstrate: i) Was in its possession prior to being received from the Discloser and was not acquired, directly or indirectly, from the Discloser, or ii) Was in the public domain, at the moment of being received from the Discloser, or iii) Became part of the public domain through no fault of the Recipient, after having been so communicated, or iv) Was lawfully received by the Recipient from some third party having a right of further disclosure, or v) Is required by law, regulation, rule, act or order of any governmental authority or agency to be disclosed by Recipient. D. Ownership. Each party hereto is, and shall remain, the exclusive owner of its Confidential Information and all patents, copyright, trade secret, trademark and other intellectual property rights therein. No license or conveyance of any such rights is granted or implied under this Agreement. E. Transmittal of Information. The parties agree that information exchanged under this Agreement, including Confidential Information, may be transmitted via facsimile or electronic mail, or sent via regular or express mail. F. Survival of Terms. The Confidential Information provisions in this Agreement will survive the termination of this Agreement for any reason.F-135-001, Institutional Master Service Agreement, 18Jun2012 Page 3 of 6
1601 Fifth Ave. Suite 1000 Seattle, WA 981014. NOTICE All notices relating to the terms of this Agreement shall be delivered personally, by facsimile, by e-mail, by registered or certified first class mail, or by overnight courier service to the contact addresses set forth below. Notice shall be effective upon receipt if personally delivered, delivered by e-mail or delivered by facsimile; upon the third business day following the date of mailing by registered or certified first class mail; or on the first business day following the date of delivery to the overnight courier. A party may change its address listed below by written notice to the other party. If to Institution: [include information here] If to Quorum: Quorum Review, Inc. 1601 Fifth Avenue, Suite 1000 Seattle, WA 98101 Attn: Director, Customer Relations & Marketing5. COMPENSATION A. IRB Review Fees. Quorum will charge for services in accordance with its published fees in effect at the time that services are rendered. For new studies submitted to Quorum, Quorum shall bill Institution, investigators or sponsors, or their agents, for services rendered as directed upon the applicable submission form(s); provided, however, that if Quorum does not receive payment within ninety (90) days of invoicing, Institution shall be responsible for payment of such services regardless of the original billing contact instruction noted in the submission form(s). B. Institution-Sponsor Contract. Institution will use its best effort to maintain a contractual agreement with each sponsor and/or investigator in which the sponsor and/or investigator agrees to make payments as specified in this Section directly to Quorum for services rendered. C. Survival Upon Termination. The Compensation provisions of this Agreement will survive termination of this Agreement for any reason.6. TERM AND TERMINATION A. The term of this Agreement shall commence upon execution of this Agreement by both parties, and shall continue until such time as either party gives sixty (60) days written notice of termination. Notwithstanding the foregoing, in the event that either party is in default in the performance of any of its obligations under this Agreement, and the default has not been remedied within thirty (30) days after the date of notice in writing of such default, the party not in default may terminate this Agreement immediately by written notice. B. Notwithstanding the immediately preceding paragraph, the parties specifically recognize that 21 CFR § 56.109(f) requires that, “An IRB shall conduct continuing review of research . . .not less than once per year, and shall have authority to observe or have a third party observe the consent process and the research.” Therefore, termination of this Agreement shall not affect Quorum’s obligations of continuing review for studies approved hereunder or Institution’s payment responsibilities until such studies are transferred to and re-reviewed by the responsible IRB.F-135-001, Institutional Master Service Agreement, 18Jun2012 Page 4 of 6
1601 Fifth Ave. Suite 1000 Seattle, WA 9810113. SEVERABILITY In the event that any court of competent jurisdiction shall hold any provision of this Agreement invalid or unenforceable, such holding shall not invalidate or render unenforceable any other provision hereof.14. HEADINGS The headings used in this Agreement are inserted only for convenience, and shall not be construed in the interpretation of this Agreement.15. AMENDMENT/MODIFICATION This Agreement shall not be subject to any change or modification unless such modification is signed by both parties and specifically states that it is an amendment to this Agreement.16. NO THIRD PARTY BENEFICIARIES This Agreement is not intended to and shall not confer upon any other person or business entity, other than the parties hereto, any rights or remedies with respect to the subject matter of this Agreement.17. ENTIRE AGREEMENT This Agreement and the Exhibits attached hereto constitute the full understanding between the parties with reference to the subject matter hereof, and no statements or agreements by or between the parties, whether orally or in writing made prior to or at the signing hereof, shall vary or modify the written terms of this Agreement.IN WITNESS WHEREOF, each party accepts the terms herein as evidenced by their authorized signaturesbelow.[Institution] QUORUM REVIEW, INC.(Authorized Signature) (Authorized Signature)Name: Name:Title: Title:Date: Date:F-135-001, Institutional Master Service Agreement, 18Jun2012 Page 6 of 6
Quorum Review Institution Cover Page Institution (customized for each Institution with an MSA) Logo Here For prompt assessment and Board review, Institution site submissions are submitted with the Site Information Questionnaire (SIQ) and should contain general elements as noted in the Site Submission Checklist found on Quorum’s website at www.quorumreview.com. Including the Institution Cover Page will ensure proper handling of your initial site submission. NAME OF INSTITUTION PRINCIPAL INVESTIGATOR PROTOCOL NUMBER SPONSOR NAME Investigator Unique / Modified Consent Forms If you are a site participating in a central study for which Quorum is the central IRB, the Study Manager, or sponsor for the above protocol, can provide you with the current approved copy of the model consent form for review. Please indicate below how your consent form should be handled for the above study. 1. This Institution HAS “locked-in” client template consent 2. This Institution DOES NOT have “locked in” client language with Quorum. If this is a single-site or PI-generated template consent language with Quorum. Please process our study, you do not need to check any additional boxes below. consent form according to the applicable sections of the SIQ. If you are a site in a central study for which Quorum Review is the central IRB, please check one of the boxes below. NOTE: If your institution does not have “locked-in” client For this study, my Institution requests to: template language, you may request to begin the process for a. Use the model consent form only and do not future studies by contacting Quorum’s Client Relations include our “locked-in” template language. Group at 206-448-4082 or b. Use the model consent form incorporating our ClientRelations@QuorumReview.com. institution’s “locked-in” template language (sponsor approval must be included). c. Use the model consent form incorporating some of our institution’s “locked-in” template language for the sections listed here (sponsor approval must be included): d. Use the model consent form including our institution’s “locked-in” language and additional unique changes not previously negotiated (tracked consent form is attached along with rationale and sponsor approval). 3. Please give portal account access to the following Institutional official or designee: Name: Email address: THIS SECTION DESCRIBES CURRENT HANDLING REQUIREMENTS FOR THE INSTITUTION ABOVE AND IS FOR QUORUM USE ONLY <<Insert instructions to staff here>>Quorum/Institution Agreement Version: 11/29/2011
1601 Fifth Ave. Suite 1000 Seattle, WA 98101 www.QuorumReview.com Guide to Consent Form DevelopmentQuorum Review edits submitted consent forms to ensure accuracy, to clarify ambiguity, and to confirm: Each consent form is in compliance with applicable regulations in the United States and Canada Each consent form accurately reflects the protocol Each consent form addresses specific Quorum preferences for participant protection Quorum’s Editing Processes1. Quorum edits each consent form using the “Track Changes” feature in Microsoft Word, which changes the colorof modified text. The feature also strikes through deleted language (lining through) and underlines all newly addedlanguage. Edits to consent forms are followed by a superscript number representing the rationale for the specificchange. (Please see below for the list of superscripts and their rationales.)2. The study manager will send tracked and clean versions of each consent form to the customer for review.3. The customer should review each form and submit requested changes as tracked-in revisions to the cleanWord document. Quorum requires written rationale for each of the requested changes. The rationale may be adocument separate from the revised consent form, or it may consist of comments inserted into the revised consentform. The Study Manager may request clarification if the customer does not provide rationale.4. Quorum reviews the customer’s changes.5. The study sponsor provides written acceptance of the finalized consent form. After a form is finalized, anytypographical or administrative errors that do not affect participant comprehension will be corrected andredistributed only if the customer desires and is willing to pay for these costs.To ensure consistency across studies from the same customer, Quorum encourages customers to develop “locked-in” template language to be used for every study. Contact Quorum if you are interested in creating a template. Superscripts and Their RationalesSuperscript RATIONALE FOR CHANGE #1 Required by FDA regulations and guidance, ICH guidelines, or local laws #2 Accuracy (to reflect protocol specifications) #3 Coercive/overly reassuring language; Board preference (e.g., “study drug,” not “medication”) #4 Sponsor-required words, phrases, paragraphs, or changes #5 Duplication of information #6 Improve participant protection and/or safety #7 Moved from another area of consent form #8 Changed point-of-view #9 Simplification of language for readability; clarification, consistencyGuide to Consent Form Development: - Version 8, dated 10/26/2008
Umbrella Institutional Authorization AgreementName of Institution or Organization Providing IRB Review: Quorum Review IRB (Quorum) Quorum’s IRB Registration #: IRB00003226 Federalwide Assurance (FWA) #, if any: N/AName of Institution Relying on the Designated IRB (Institution): Institution’s OHRP Federalwide Assurance (FWA) #: The Officials signing below agree that Institution shall rely on Quorum Review IRB for review and continuing oversight of some or all of the human subjects research covered by the Institution’s FWA.The review performed by Quorum will meet the human subject protection requirements of the Institution’sOHRP-approved FWA. Quorum will follow written procedures for reporting its findings and actions to the PI,Sponsor, and appropriate officials at the Institution. Therefore, at a minimum, Quorum will send “Default”documents to the Institutional Official. Relevant minutes of IRB meetings will be made available to the Institution ifrequested. Document (X) Access Description Requested As defined by Quorum, “Default” documents include the following: a. Notice of Partial Clinical Holds and Partial If “ALL” or “STANDARD” Clinical Hold Lift Letters is not selected, Quorum b. Notice of Suspension and Suspension Lifts Default will send the Institution c. Notice of Termination “Default” documents d. Notice of Unanticipated Problem Involving Risks to Participants or Others e. Notice of Serious Noncompliance Letters f. Notice of Disapproval As defined by Quorum, “Standard” documents include the following: a. All “Default” documents; and b. Letters of Inquiry and other letter directed by the Standard Board; and c. Site Visit Letter and Site Visit Acknowledgements; and d. Reprimand Letters As defined by Quorum, “All” documents include the following: All a. All “Default” documents b. All “Standard” documents; and c. All other study-related documents Desired Schedule: Quarterly Meeting Minutes Monthly Other:F-119-002, Umbrella Institutional Authorization Agreement, 2011-Oct-03 Page 1 of 2
Umbrella Institutional Authorization AgreementInstitution remains responsible for ensuring compliance with Quorum’s determinations and with the Terms of itsOHRP-approved FWA. This document must be kept on file by all parties and provided to FDA, OHRP, and/orother applicable regulatory agencies upon request. This Agreement may be executed in any number ofcounterparts, either in original or faxed form.Each party listed below is authorized to exchange information pursuant to this Agreement and agrees to treatsuch information as confidential (Confidential Information). No Party shall disclose Confidential Informationreceived pursuant to this Agreement to any individual or entity other than another Party without prior writtenapproval of all Parties. Notwithstanding the foregoing, nothing in this Agreement shall be construed to restrict aParty from disclosing Confidential Information as required by law, subpoena, court order, or other governmentalorder or request. Additionally, nothing in this Agreement shall restrict a Party from disclosing that Quorumreviews research for the Institution.Quorum or its authorized representatives shall be permitted to: (1) examine and inspect Institution’s facilities usedfor the performance of its research, including storage and use of any investigational products; (2) observe theconduct of the research performed at the Institution; (3) inspect and copy all documents relating to its studies,including study records and informed consent document, investigational product logs, required licenses,certificates and accreditations; and (4) interview all necessary personnel involved in the research conduct of itsstudies.Signature of Signatory Official (Quorum):Print Name: Date:Title:Signature of Signatory Official (Institution):Print Name: Date:Title:F-119-002, Umbrella Institutional Authorization Agreement, 2011-Oct-03 Page 2 of 2
Institutional Authorization AgreementName of Institution or Organization Providing IRB Review: Quorum Review IRB (Quorum) Quorum’s IRB Registration #: IRB00003226 Federalwide Assurance (FWA) #, if any: N/AName of Institution Relying on the Designated IRB (Institution): Institution’s OHRP Federalwide Assurance (FWA) #: The Officials signing below agree that Institution waives jurisdiction of the research described below and shall rely on Quorum Review IRB for review and continuing oversight of the following human subjects research: Name of Research Project: Name of Principal Investigator: Name of Sponsor: Name of Funding Agency: Award Number, if any:The review performed by Quorum will meet the human subject protection requirements of the Institution’sOHRP-approved FWA. Quorum will follow written procedures for reporting its findings and actions to thePI, Sponsor, and appropriate officials at the Institution. Relevant minutes of IRB meetings may be madeavailable to the Institution by Quorum upon request. PI is responsible for ensuring compliance with theBoard’s determinations. Institution remains responsible for ensuring compliance with Quorum’sdeterminations and with the Terms of its OHRP-approved FWA. This document must be kept on file byall parties and provided to FDA, OHRP, and/or other applicable regulatory agencies upon request. ThisAgreement may be executed in any number of counterparts, either in original or faxed form.Each party listed below is authorized to exchange information pursuant to this Agreement and agrees totreat such information as confidential (Confidential Information). No Party shall disclose ConfidentialInformation received pursuant to this Agreement to any individual or entity other than another Partywithout prior written approval of all Parties. Notwithstanding the foregoing, nothing in this Agreement shallbe construed to restrict a Party from disclosing Confidential Information as required by law, subpoena,court order, or other governmental order or request. Additionally, nothing in this Agreement shall restricta Party from disclosing that Quorum reviews research for the Institution.Quorum or its authorized representatives shall be permitted to: (1) examine and inspect Institution’sfacilities used for the performance of this research, including storage and use of any investigationalproducts; (2) observe the conduct of the research performed at the Institution; (3) inspect and copy alldocuments relating to the Study, including study records and informed consent document, investigationalproduct logs, required licenses, certificates and accreditations; and (4) interview all necessary personnelinvolved in the research conduct of the Study.Signature of Signatory Official (Quorum): _________________________________________________ Print Name: ________________________________________ Date: _____________Signature of Signatory Official (Institution): _________________________________________________ Print Name: ________________________________________ Date: _____________Signature of Principal Investigator: ______________________________________________________ Print Name: ________________________________________ Date: _____________F-034-003, Institutional Authorization Agreement, 2011-Oct-03 Page 1 of 1