Health Informatics Ethics Approval Application
1. Project Information
Project Title
Project Summary
Proposed Start Date
Proposed End Date
2. Principal Investigator Details
Name
Affiliation
Email
Phone
3. Team Members
List all team members and roles
4. Research Ethics
Describe the ethical considerations of your project
Type of Data Used
Source of Data
Describe the informed consent process
5. Data Handling & Privacy
Describe how data will be stored and protected
Who will have access to the data?
Methods of de-identification/anonymization
6. Risk Assessment
Potential Risks to Participants
Describe risk mitigation strategies
7. Additional Comments
Any additional information for the committee