Procedures to Initiate a Research Study
Billing mechanisms must be in place BEFORE requesting laboratory services. Set up a research T-Account so your grant will be billed instead of the patient. Fill out the
T-Account Billing Request Formand submit by email or fax to:
Phone: (203) 688-9003
Fax: (203) 688-3330
To obtain clinical laboratory tests or services for human research studies, submit:
Request for Human Subjects Research Form
The T-Account number, the HIC number and HIC approval letter must be provided.
If excess clinical samples are requested, submit an additional form:
Excess Clinical Samples (HIPAA) Form.
An HIC signature is required if the samples will have identifiers or codes of any kind.
For individual patient samples submitted for testing, obtain Blue T-Account Requisitions from the Laboratory Medicine Research Coordinator. Use to submit individual patient samples charged to a T-Account. Enter the T-Account number prominently at the top left.
For pre-aliquoted samples brought to the lab for batch testing, obtain a Special Study Protocol Form instead of the Blue T-account Requisition. Contact the individual laboratory for details.
To obtain clinical laboratory tests for non-human research studies, obtain a T-Account as above and submit the
To aid in preparation of budgets, a pricing estimate can be requested using the Request for Pricing Only Form. This estimate is based on handling and testing that is identical to a routine clinical sample. Any deviation from the routine will incur additional charges.
Forms described in B or C above must be submitted and approved before sample submission and testing can begin. Prices are valid for the current fiscal year only.
Obtain a T-Account, PTAEO number, and HIC approval, and submit Request for Phlebotomy Only Form to email@example.com. Arrangements for specimen pickup and drawstation location must be made in advance. The phlebotomists will not centrifuge, deliver or mail specimens.
Billing will be done quarterly at a minimum. If the PTAEO changes, it is the responsibility of the researcher to notify firstname.lastname@example.org in advance of the change.
Phlebotomy service for research studies is not guaranteed, but will depend on both study requirements and laboratory resources.