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:

Charise Berghaus
T-Account Coordinator
Email: Charise.Berghaus@ynhh.org
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

Request for Non-Human Research Form.

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 deborah.anthony@ynhh.org. 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 deborah.anthony@ynhh.org in advance of the change.

Phlebotomy service for research studies is not guaranteed, but will depend on both study requirements and laboratory resources.