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Pathology Protocol Review Committee

Questionnaire For  Use of Human Biological Samples in Research 

Please, email form to the attention of Maritza Polania at mpolania@med.miami.edu

INSTRUCTIONS:  Complete this form if the research consists of using, collecting or storing human biological samples for other than routine testing.  This form must be typed and completed in its entirety.  Incomplete forms will delay the approval process. Please submit a copy of the protocol.

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Notification and Tissue Release Form


How this process works:

The PI or Research Coordinator must complete this form 48 hours prior to the need for Laboratory services. Patient Consent forms must be signed and emailed to Pathology in conjunction with this document ATTN: Maritza Polania, mpolania@med.miami.edu. Specimens will not be released lacking completion of this document and or consent form.


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