The Feinstein Institute for Medical Research

Empowering Imagination. Pioneering Discovery.

Application & Request Forms

The following forms are commonly used for research purposes.

Research Billing Forms: The outpatient/Inpatient registration forms must be utilized by the research staff to identify the “research” service (fund #) that is being ordered for the patient in study. The completed forms must be submitted to patient registration along with prescription & email a copy to both clinicaltrialsfinance@nshs.edu and crs@nshs.edu.

CRS application form: Application used to solicit nursing and coordinator services from Clinical Research Center.

ClinCard Application Form: Clincard application used for subject compensation and ensures efficient timing and tracking of patient compensation.

Make-it-right form: The Clinical Research Service has begun the Make It Right Initiative as a way to provide coordinators with support in order to ensure superb research participant experience.

Recruitment core database request form: Application to request the use of Feinstein Recruitment Registry Database.

Investigator Directions for Human Subject Recruitment Requests: Directions on how to use Feinstein Recruitment Registry Database.

Post a study on Feinstein website form: Application to request posting of IRB approved study on Feinstein website.

Time & effort form: To certify the percentage of effort individuals devote to all of their activities in the health system when any part of their effort is devoted to a grant-funded project.

New account setup (Core lab): Application to setup an account to utilize the Core lab services.

Certificates for Participation