All Project Approval Form (APAF)
project approval form
Your Full Name
Your Email Address
Verify Your Email Address
Title of Your Proposed Project
Purpose of Your Project
Your Project Objectives
Your Project Abstract
How Does Your Project Relate to SinfoniaRx/MMA Mission and Goals? (See SinfoniaRx and College of Pharmacy Medication Management Center websites for details)
Project Type (e.g., Research Team, Student, Senior, QI, Resident, Fellow)
Determination of IRB approval. Submission required if project is related to SinfoniaRX, University of Arizona Medication Management Center and/or planning to present and/or publish the project.
Final determination of IRB submission will be determined by the approvers
Project Timeline (e.g., Provide the inclusive dates for conducting the project)
Major Professor/Advisor (if applicable)
Study Design (e.g., Randomized controlled trial, quasi-experimental, retrospective review, systematic review/meta-analysis,mixed methods)
Target Population (e.g., patients with diabetes, hypertension; patients receiving care from XXX health plan)
Are human subjects involved? If so, provide specific information (e.g., inclusion/exclusion criteria, projected sample size, etc.)
Does the project involve an intervention or interaction with individuals?
Is data required?
What types of data are required? (e.g., 1. Claims data/health plan data - last medication fill for patient, classes of medications; 2. Data created by SinfoniaRx - interventions completed, number/type of recommendations made)
What datafields are absolutely required? Please INDICATE all that apply from the fields below.
Member's medical conditions
Member's prescriber information for where faxes were sent
Member's pharmacy information
If the patient is in a PDP or MAPD plan
Is the intent to conduct a systematic investigation to develop or contribute to generalizable knowledge? Is the plan also to present at external venues and/or publish the results? (e.g., outside the UA, MMC, and/or SinfoniaRx). The following definitions are from the Determination of Human Subjects Form: *Systematic: having or involving a system, method or plan. ·* Investigation: a searching inquiry for ascertaining facts; detailed or careful examination. *Generalizable: is the extent to which research findings and conclusions from a study conducted on a sample population can be applied to the population at large.
FOR OFFICIAL USE ONLY
Is IRB approval required?
Timeline for DUA
When you have completed your review, please check your name off from the list below and email the next reviewer to begin their review of the survey.
Kevin Boesen - final determination (e.g., Accept, Reject, Accept with Revisions) via official, signed letter
Accept with Revisions
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