Must comply with CPHS (Committee for the Protection of Human Subjects), HIPAA (Health Insurance Port 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Study Title' at the top of the form. This should clearly reflect the focus of your research.
3. Fill in the 'Principal Investigator' section with your name, followed by your contact information including phone number and email.
4. Indicate your department and funding source in the respective fields to provide context for your study.
5. Answer whether a DII Radiologist/Faculty is involved by checking 'Yes' or 'No'. If yes, provide their name, role, and effort details.
6. List all requested DII Radiologist services for your research, selecting from options like 'Protocol Development' or 'Read/Interpret'.
7. Select all imaging procedures relevant to your project from the provided checklist to ensure comprehensive coverage of your study's needs.
8. Specify applicable scan/procedure sites for this research study to clarify where imaging will take place.
9. Complete any additional comments or target enrollment information as necessary before submitting the form.

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