Retrospective/Chart or Record Review

Please download the following pdf to review the RRIC Requirement for Written Research Proposal for Chart Review.

Competing Clinical Trials

Reference Materials
CCMB Policy 02.015


Exempt Study form applies only to the following one group:

  • Departments of Medical Physics

This form must be completed for all studies that do not meet the criteria for full review by the RRIC.

Criteria for full Review by the RRIC:

Your study:

  • Involves the review of patient charts (electronic or paper)
  • Involves any type of contact with participants (including surveys and questionnaires)
  • Involves the use of tissue or body fluids
  • Has significant impact on CCMB resources (staff, equipment, or other) and which may adversely affect the availability of those resources for routine patient care

If the answer to all the above questions is "no", then please complete the Exempt Study Form to apply for an exemption.

Potential Patient/Family Emotional Distress

If study participants are CancerCare Manitoba patients or significant others for whom participation in the study may cause anxiety or emotional distress, it is recommended that the following paragraph be included in the information for participants. Sign off from the Director of Patient and Family Support Services will also be required.

"Participation in this study may be upsetting or distressing to you as you recall your own illness experience, or the experience of your family member. If you would like to talk to someone about this, there is support available through CancerCare Manitoba Patient and Family Support Services. Please call 204-787-2109 or toll free 1-800-561-1026, or ask the research study staff to refer you."

Privacy / PHIA

Manitoba's Personal Health Information Act (PHIA) was legislated June 28, 1997. CancerCare Manitoba, as a trustee, shall protect personal health information by adopting reasonable administrative, technical, and physical safeguards that ensure the confidentiality, security, accuracy and integrity of the information.

As a trustee, CancerCare Manitoba will limit on amount of information used or disclosed. Every use and disclosure by a trustee of personal health information must be limited to the minimum amount of information necessary to accomplish the purpose for which it is used or disclosed.

It is important that research studies comply with the Act to:

  1. Limit collection of identifiable personal health information. Participant should be assigned a study number. All efforts to de-identify shall be made.
  2. If study participant personal health information will be disclosed, obtain signed consent from participant.
  3. Limit access to study information. Researchers should be aware of the Personal Health Information Act, and sign a pledge of confidentiality.
  4. Safeguard study information that has been collected. Consider, how will this information be stored ie. Stored in a locked filing cabinet, not removed off premises, computer is password protected, computer data encrypted? CD/disk use and storage, use of USB keys. Information must be protected.
  5. How long will the data be retained, and how will it be destroyed once the study is completed.

PHIA Orientation & Pledge Forms (Note: The PHIA orientation and pledge forms are only required if you have not received prior PHIA training)

If you answered "no" to question 8.3 on the RRIC Submission form and/or question 8 on the PHIA form for research, please complete the PHIA Checklist and PHIA Pledge. All completed forms must be submitted to the Health Information Services Privacy Office (ON2092 - 675 McDermot Avenue)

For questions about forms, submission dates, and the submission process, please contact [email protected] (RRIC Coordinator). The RRIC submission forms are available in the Forms section. If you are uncertain whether a study or chart review needs to be reviewed and approved by the RRIC, please contact RRIC Coordinator.