URMC / Psychiatry / Our Divisions / Medicine in Psychiatry Services / MIPS Research Request MIPS Research Request Research Project Title of the project: Principal investigator and co-investigators: Proposed start date and duration of project.: What is the question your study is trying to answer?: Type of research (check all that apply): ObservationalInterventionRandomized Control TrialImplementationComparative EffectivenessCommunity-based ParticipatoryQuality ImprovementTranslational researchOther If you choose Other, please explain: Potential benefit and risks to patients and/or MIPS: Target population and proposed plans for recruitment, including how patients will be identified, contacted and consented: Will the project require any practice resources (e.g. mailings, copying, space etc)? Please describe: Will the project require any Medicine in Psychiatry staff time (e.g. creating data queries, hanging flyers, making phone calls, recruiting/consenting patients)? Please describe: Will the project require any clinician time (e.g., mentioning the study, recruiting for the study)? Please describe : Important: After submission, please do not leave this form until you see the confirmation message.