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/^((0?[1-9])|([1-8][0-9])|(9[0-8]))[0-9]{3}$/

/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))$/

/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/

/^(?!\.)((?!.*\.{2})[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)(\.[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)*@(?!\.)([a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF\-\.\d]+)((\.([a-zA-Z\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF]){2,63})+)$/i

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/^\d{10}$/

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/^[-+]?[0-9]*\.?[0-9]+([eE][-+]?[0-9]+)?$/

/^-?\d+,\d$/

/^-?\d+\.\d$/

/^-?\d+,\d{2}$/

/^-?\d+\.\d{2}$/

/^-?\d+,\d{3}$/

/^-?\d+\.\d{3}$/

/^-?\d+,\d{4}$/

/^-?\d+\.\d{4}$/

/^[-+]?[0-9]*,?[0-9]+([eE][-+]?[0-9]+)?$/

/^($0[2-8]$|0[2-8])\s*\d{4}\s*\d{4}$/

/^(?:$?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9]|800|811)$?)\s*(?:[.-]\s*)?([0-9]{3})\s*(?:[.-]\s*)?([0-9]{4})(?:\s*(?:#|x\.?|ext\.?|extension)\s*(\d+))?$/

/^((((\+44|0044)\s?\d{4}|$?0\d{4}$?)\s?\d{3}\s?\d{3})|(((\+44|0044)\s?\d{3}|$?0\d{3}$?)\s?\d{3}\s?\d{4})|(((\+44|0044)\s?\d{2}|$?0\d{2}$?)\s?\d{4}\s?\d{4}))(\s?\#(\d{4}|\d{3}))?$/

/^\d{4}$/

/^[ABCEGHJKLMNPRSTVXY]{1}\d{1}[A-Z]{1}\s*\d{1}[A-Z]{1}\d{1}$/i

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/^\d{3}-\d\d-\d{4}$/

/^(\d|[01]\d|(2[0-3]))(:[0-5]\d){2}$/

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/^[0-5]\d:[0-5]\d$/

/^[0-9]{4,9}$/

/^\d{5}(-\d{4})?$/

Q8Y9sAMPHvDLx5oi3WjdR5mCG

Study Intake Form

Please complete this form to notify the IH Research Department of your study. Once submitted, you will receive an automated, personalized link to begin your application for Operational Approval.

The information gathered on this form is collected under the authority of section 26c of the Freedom of Information and Protection of Privacy Act of British Columbia (RSBC 1996) ("FIPPA"). This information will be used for administrative, financial and statistical purposes of the Interior Health Research Department including, but not limited to: operational approvals, maintenance of study records, monitoring, evaluation, and reporting. Questions regarding the collection or use of this information should be directed to the Interior Health Research Department located at 505 Doyle Ave, Kelowna, BC (research@interiorhealth.ca).

Study Title

* must provide value

Study Nickname

Has this study been submitted to the IH Research Ethics Board (REB)?

Yes No

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Has this study been submitted to a Research Ethics Board outside of Interior Health?

Yes No

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Please specify

If this study was not submitted directly to the Interior Health REB, ensure that you have requested harmonized review with Interior Health. Visit the Research Ethics BC website for more information:
https://healthresearchbc.ca/

IH ID number (if known)

Describe your plans for REB review

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Is your study a Clinical Trial?

Yes No

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With whom in the Research Department have you spoken regarding a Clinical Trial Agreement?

Please be advised that a Clinical Trial Agreement is a requirement for all Industry Sponsored Clinical Trials being conducted within Interior Health. If have not already done so, please contact research@interiorhealth.ca for further information regarding next steps.

Is this study being done to fulfill requirements for an academic degree ?

Yes No

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First Name

Last Name

Position / Job Title

Department or Program

Institution / Primary Affiliation

IH Affiliation:

IH employee

IH credentialed physician

External investigator (IH affiliated status)

External investigator (no IH affiliation)

You can request an appointment for IH Affiliated Investigator status here: https://is.gd/IHaffiliation

Phone

Street Address

City

Province

Postal Code

I am a student:

Yes No

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Students with no IH affiliation must have their academic supervisor act as PI for this application.

Institution and program name:

Supervisor Name

Supervisor Title

Does this study also have an Interior Health site lead (e.g., IH Co-Investigator or Qualified Investigator)?

Yes No

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First Name

Last Name

Position / Job Title

Department or Program

Institution / Primary Affiliation

Is the PI also the primary contact for this project?

Yes No

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First Name

Last Name

Position / Job Title

Department or Program

Institution / Primary Affiliation

All email notifications relating to this application will be sent to the primary contact email address.

Phone

Street Address

City

Province

Postal Code

I am a student:

Yes No

reset

Institution and program name:

Supervisor Name

Supervisor Title

Date of Intake

Y-M-D

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