Policies and Forms

Patient form

KHSC policies and forms for research and research-related activities


The following policies and forms have been developed to support your research activities. If you have any questions or concerns, please contact:

Smita Sengupta
Director, Research Financial Affairs 
Kingston Health Sciences Centre
Kingston General Hospital Site
W.J. Henderson Centre for Patient-Oriented Research
Connell 4, Room 2-4-018-2  
76 Stuart Street
Kingston ON K7L 2V7
Tel: (613) 549-6666 ext.6844


Access to Personal Health Information 09-140

Contract Management - Procurement of Goods and Services 03-005 

Disclosure of Personal Health Information 09-050

Facility Planning 05-135 

Personal Health Information Protection 09-055

Research and Clinical Trials Overhead 11-151

Research Hospital Appointment 11-012 

Research Restricted Accounts 03-021

Standard Operating Procedures for Clinical Research 11-152

Travel and Hospitality 03-080 

Queen's Research Policies


 Research Hospital Appointment Application Package

Confidentiality Agreement for Non-Hospital Individuals

Data Request Form (Appendix A) 11-150

Hospital Departmental Impact and Information Form (version July 2020)

KHSC Computer Access Request Form (November 2016)

KHSC Pharmacy Services Study Request Form (version May, 2020)

KHSC Laboratory Services Study Request Form (version November 2019)

KHSC Clinical Engineering Services Study Request Form (version March 2018)

KGHRI Research Restricted Account Agreement Form (Appendix A) 03-021

KGHRI Terms of Reference Form (Appendix B) 03-021

Move Form (Appendix C) 05-135

Request for KGHRI Email Domain

Space Request Form (Appendix B) 05-135

Statement of Confidentiality and Hospital Principles (Appendix B) 11-150 (version June 2018)