This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range.

The value you provided is outside the suggested range.

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

/^((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

/^[-+]?\b\d+\b$/

/^([1-9]|[1][0-9]|[2][0]|-[9][9][9]|-[9][9][7])$/

/^([B])([V])\d{8}$/

/^([E])\d{9}$/

/^([Jj])([Hh])\d{8}$/

/^[a-z]+[0-9]+@jh.edu$/

/^[a-z]+$/i

/^\d{10}$/

/^[a-z0-9-_]+$/i

/^[-+]?[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]+)?$/

/^(\d*|\d*\.[05])$/

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

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

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

/^\d{4}$/

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

/^(0[1-9]|[1-9]\d)\d{3}$/

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

/^([0-9]|[0-1][0-9]|[2][0-3]):([0-5][0-9])$/

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

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

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

MDsHvUNVLVybUuKxC36hkMdT9PSwNPE4YTCXdVd5QC2gct4RBF9YZsCWtzVoqZRQfZ7VnHF6sspjN2DSjgXTeKKkMSysyrx34Fm

JHCP Research Project Application - NEW!

Hello!
Thank you for taking the time to fill out this short questionnaire. The JHCP Research Department looks forward to collaborating with you on your research project. Please feel free to reach out to someone on our team for help with this form, questions about participating with JHCP or to talk strategy about research implementation at any of our sites. We are here to help!

Johns Hopkins Community Physicians, INC. (JHCP)
Research Director: Wendy Bennett, MD, MPH
Research Program Manager: Sarah Rubin srubin19@jhmi.edu
Research Program Coordinator: Kate Holzhauer kholzha1@jhu.edu

What to Expect:
After submitting this form a member of the study team will contact you.
Then, your study will be reviewed by the JHCP Research and Projects Committee. The goal of this review is to ensure the success of your project by facilitating collaboration between your research team and JHCP sites.

We are looking forward to working with you!

JHCP Research and Projects Committee

Admin Only Information

M-D-Y

D-M-Y

None

RPC

RET/Email

Research Director

BMS

Yes

reset

Approved

Acknowledged

Pre-IRB

Under review

Lapsed

Terminated

reset

Yes

reset

M-D-Y

Expand

Yes

reset

JHU School of Medicine IRB

JH Bloomberg School of Public Health IRB

Western IRB

Central IRB (Non-Hopkins IRB)

Non-Central (Non-Hopkins IRB)

N/A

reset

View equation

This box should only be checked if you are conducting a QI study.

If you are conducting a research study and/or have a non-hopkins IRB, you will be required to submit to either the School of Medicine or School of Public Health IRB for review.

If you have any questions, please contact Sarah Rubin, JHCP Research Program Manager srubin19@jhmi.edu

JHCP requires all projects to be approved or acknowledged by a Hopkins' IRB.

If you have any questions, please contact Sarah Rubin, JHCP Research Program Manager, at srubin19@jhmi.edu

M-D-Y

Yes

reset

Expand

All JHCP Primary Care Sites (NOT including EBMC)

All JHCP Sites (includes ALL specialties, NOT including EBMC)

OB/GYN Practices (specify below)

Heart Care (specify below)

Surgery (specify below)

Pediatric Sites (specify below)

Annapolis

Bayview

Bowie

Brandywine

Canton Crossing

Charles County

Downtown Bethesda

EBMC (Please Note: to conduct research at EBMC will require a concurrent and separate process as it is no longer part of JH)

Frederick

Fulton

Germantown

Glen Burnie

Greater Dundalk

Green Spring Station

Hagerstown

Howard County

I Street

JHome

Montgomery Grove

North Bethesda

Odenton

Remington

Sibley Hospital Medicine

Urbana

Water's Edge

Westminster

White Marsh

Other Site(s) not listed (specify below)

Bowie (Family Practice)

Canton Crossing

EBMC (Please Note: to conduct research at EBMC will require a concurrent and separate process as it is no longer part of JH)

Glen Burnie (Family Practice)

Howard County

Odenton

Remington

Water's Edge

White Marsh

Canton Crossing

EBMC (Please Note: to conduct research at EBMC will require a concurrent and separate process as it is no longer part of JH)

Howard County

Odenton

Remington

Bethesda

Chevy Chase

Rockville

Silver Spring

Expand

Recruit Patients

Recruit Providers

Recruit Staff

Post Flyers

Review Charts

Request Data

Other (specify below)

Expand

Upload file

The project is not specifically looking at JHCP or breaking out JHCP data separately for analysis and reporting.

The project will be receiving JHCP encounter, location, or provider information but will not be assessing care quality, performance, or differences across sites or providers.

The study is requesting data that includes JHCP sites and provider identifiers and will be reporting quality, performance, or outcomes by site or provider.

N/A

reset

Retrospective review of medical records

Directed physical mailings to JHCP patients

Directed mailings to JHCP providers

General Advertisement

Literature/Flyer in waiting area

Literature for clinical staff

Provider/Social worker referral

Study staff will have table in waiting area

MyChart Recruitment

Other

Expand

Educational Support

Administrative Support

Clinic Champion Support

Office Space

Clinical Space

Other

Expand

Upload file

You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.

The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.