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Intermountain Healthcare

Reporting Adverse Events

There are two types of forms associated with reporting adverse events to the Institutional Review Board. Please utilize the Internal Adverse Event Form for all adverse events associated with patients in the care of the investigator at your specific site; or use the External Adverse Event Form for all adverse events with patients not associated with your specific site.

Note: All forms are fillable Word documents. Please fill out forms completely, utilizing the gray shaded areas to enter text. Incomplete forms may be returned and the application process delayed.

Internal Adverse Event Form