The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

22XDamfMYCzZdGu5RmyiMNtZICHDoGQHWYeMEyzxWJxFmVsPjI4n3kxNXN

Study Amendment Form

Instructions: Any changes to the originally approved study must be submitted for review and approval in advance of their implementation.

Note: If you wish to make changes to study personnel, please use the 'Change in Study Personnel' online form to update the list of study personnel who have access to study data.

Complete each section below.

Date of Report:

D-M-Y H:M:S

RRIC/RSO #

* required field

Principal Investigator

* required field

Title of Research Project

* required field

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Select Amendment Category (-ies):

Study Design

Data Collection

Administrative

Data Storage, Analysis and/or Location

Patient Informed Consent

Biospecimen collection, storage and/or transfer

Revised or New Agreement

Other

Other:

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Please attach the revised Data Capture Sheet/Case Report Form

Upload file

Please attach the revised protocol

Upload file

Please attach the revised Patient Consent form

Upload file

Has the University of Manitoba's Research Ethics Board (REB) been notified of the amendments outlined in this submission?

* required field

Yes

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Please attach your REB Amendment Submission Form and send a copy of the REB Certificate of Amendment Approval to CCMB-RSO@cancercare.mb.ca once received.

REB Amendment Form:
REB Amendment Approval Certificate:

REB review/approval is required for all amendment request(s).

For more information, click on the link: Human Ethics at Bannatyne campus | Research | University of Manitoba (umanitoba.ca)

Has the Provincial Health Research Privacy Committee (PHRPC) been notified of the amendments outlined in this submission?

* required field

Yes

Not Applicable

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Please attach the PHRPC Certificate of Amendment Approval or send a copy of the PHRPC Certificate of Amendment Approval to CCMB-RSO@cancercare.mb.ca once received.

Upload file

Please explain why PHRPC review/approval is not required for your amendment request(s):

For more information, click on the link: PHRPC Info for Researchers | Research Improvements Through Harmonization In Manitoba (rithim.ca)

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The Principal Investigator and Study Team acknowledge responsibility to maintain current, accurate and complete records pertaining to this project.

* required field

Yes

Name of Study Coordinator who completed this form

* required field

Please provide an email address to which Acknowledgment of Receipt should be sent

Note: Additional documents related to the amendment request(s) are not required at this time, however, the Research Support Office may contact the PI and/or individual who completed the form for additional information, if needed.

For questions, please contact CCMB-RSO@cancercare.mb.ca

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