VA Credentialed Physicians - Contract Status

1) Documentation of Human Subjects Training and VA Security Training

2) Without Compensation (WOC) appointment for Research Privileges
added to credentialing status (memo to the Medical Staff Office signed
by appropriate Service Chief)

3) Signed Intellectual Property Agreement (IPA)

4) Conflict of Interest Form

VA Credentialed Physicians – VA Salaried

1) Documentation of Human Subjects Training and Security Training

Fellows, Med Students, and Residents-

1) Documentation of Human Subjects Training and VA Security Training

2) Copy of appointment memo (obtained from the VA Education Office
x.15109)

3) Signed Intellectual Property Agreement (IPA)

4) Scope of Practice

5) Conflict of Interest Form

Other

1) Documentation of Human Subjects Training and VA Data Security Training

2) If NOT VA salaried, WOC appointment (submit through the appropriate
service)

3) Signed Written Release of Information

4) Signed Intellectual Property Agreement (IPA) – FOR WOC’s ONLY

5) Scope of Practice

6) Conflict of Interest Form

Exempt*

1) Documentation of Information Security 201 for Research and Development Personnel Training

2) Memorandum from PI denotes what their role in the study will be 
(specify contact with research subject(s) and data access)

3) Conflict of Interest Form

        *Exempt personnel consists persons who are not physically conducting research on VA
           property, only have access to de-identified data and/or not directly working with research
           subjects (i.e., lab personnel, data personnel, administrative personnel).

Forms:

·     Without Compensation (WOC) Packet

·     Intellectual Property Agreement

·     Scope of Practice

·     Training

·     Written Release of Information

·     Conflict of Interest Form

Related Policies:

·     07-33,  Scope of Practice for Research Personnel

·     PM 151-07-07,  Scope of Practice for Research Personnel

·     PM 151-08-04,  WOC Appointments for non-VA Staff Conducting Research

    (Attachment C is currently under revision; please contact Medical Staffing Office.)

1) VA Web-Based Animal Training Courses (For Animal Studies only) and VA ORD Biosecurity Training

2) VA Data Security Training

3) Conflict of Interest Form

Also if Not VA salaried, but physically working at the VA:

4) WOC appointment (submit WOC packet through the appropriate service of  the Principal Investigator)

5) Signed Intellectual Property Agreement (IPA) form

Forms:

·     Without Compensation (WOC) Packet

·     Intellectual Property Agreement

·     Training

·     Conflict of Interest Form

Related Policies:

·     PM 151-08-04,  WOC Appointments for non-VA Staff Conducting Research

     (Attachment C is currently under revision; please contact Medical Staffing Office.)