Instructions for Completing the

Emergency/Evacuation Card Template

IMPORTANT - Please review the following as you prepare the Emergency/Evacuation Cards:

·  DELETE this instruction page and fill in the information in [brackets] from the template in the final document. This information is meant only as a guide for researchers in preparation of the document.

·  Required for all Biomedical Studies involving multiple study visits. Not applicable for Retrospective Chart Review studies.

·  Please include the Principal Investigator’s name and a 24-hour phone contact in addition to the Human Research Protection Office phone number, 1-866-655-0014.

·  The first page is the Front, the second page is the Back.

If you have questions concerning use of the template or need assistance preparing the Emergency/Evacuation Cards, please contact the Tulane HRPO at 504-988-2665 or .

IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911

IN THE EVENT OF AN EVACUATION, CONTACT:

[Principal Investigator Name]

24-hour # - [24-hour Telephone #]

[Email address]

/ IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
/ IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
/ IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
/ IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
/ IN THE EVENT OF A MEDICAL EMERGENCY, CALL 911
IN THE EVENT OF AN EVACUATION, CONTACT:
[Principal Investigator Name]
24-hour # - [24-hour Telephone #]
[Email address]
Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014 / Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014
Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014 / Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014
Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014 / Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014
Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014 / Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014
Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014 / Principal Investigator: ______
Study ID #: ______Participant #: ______
If you are having trouble contacting
your study physician during an
emergency/evacuation, call:
Tulane University’s
Human Research Protection Office
1-866-655-0014