Sample Hospital Letter

SAMPLE HOSPITAL/UNIVERSITY LETTER

(Please use hospital/university letterhead)

{Insert date of request}

Steven L. Saltzman, M.D., F.A.C.O.G., Chairman

Sterling Institutional Review Board

6300 Powers Ferry Road, Suite 600-351

Atlanta, GA 30339

Re: Sponsor: {Name of Sponsor}

Protocol #: {Insert Protocol #}

Dear Dr. Saltzman:

This is to confirm that {Insert name of Hospital/University} maintains an Institutional Review Board (IRB) or human subjects committee and waives jurisdiction for the above mentioned protocol and accepts the review services of Sterling Institutional Review Board. This institution {does/does not} want to be copied on study related materials.

{If your institution wants to be copied on study related materials, please provide a contact name and email address. This individual will be granted access to SilverLink, Sterling IRB’s secure web portal, to retrieve documents}

Sincerely,

______

Signature Date

______

Title

(Can be signed by either a Hospital Administrator or the IRB Chairperson)

Sterling IRB – APP019 Sample Hospital/University Letter Page 1 of 1 Effective Date: 8.19.15 Version: 2.4