Download sample statement

SAMPLE STATEMENT
(to be provided by Reference Laboratory)
RE: VA Principal Investigator name, VA Protocol No., Title
Chair, Research and Development Committee
Miami VA Medical Center
1201 N.W. 16th Street
Miami, FL 33125
Biological samples received for protocol number ___________ (sponsor protocol number
_____________ [sample: DAC-1001]) will be processed exactly in the manner described in the
protocol version approved by the Human Studies Subcommittee and the Research and
Development Committee.
[option 1:] Documentation of the destruction of any unused sample materials remaining after
processing will be provided to the Research and Development Committee.
[option 2:] “After processing any unused sample materials will be returned to Dr.
_______________ (Investigator name mentioned above).”
No part, subset, or portion of these samples will be stored or used in any manner not described in
the approved protocol.
If you have any questions, please contact ___________________________________________ at
the following number (phone number).