HIPAA |
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Forms:
Tech Tip!Each form is available in two different formats, .rtf and .doc.
MAC and Linux-based operating system users should use the .doc (Microsoft Word) format only as we have experienced problems upon receiving .rtf forms from those users.
When you have completed all applicable forms, please submit them to the email address listed under 'Contact us' to the left.
 Authorized Medical Record Request Form |
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 .rtf  .doc |
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| Authorization - Template for the Release of Health Information (v05/01/09) |
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| .rtf .doc |
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| Authorization - Template for the Release of Health Information Spanish - (v05/01/09) |
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| .rtf .doc |
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| Authorization - Healthy Subjects (v05/01/09) |
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| .rtf .doc |
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| Authorization - Healthy Subjects Spanish - (v05/01/09) |
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| .rtf .doc |
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| Authorization - Minors Template (v05/01/09) |
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| .rtf .doc |
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| Authorization - Minors Template Spanish - (v05/01/09) |
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| .rtf .doc |
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| Covered Entity Checklist (v05/01/09) |
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| .rtf .doc |
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Resources:
 Glossary |
 Letter to Sponsor
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 Examples of Limited Data Sets and De-identified Medical Records |
Presentations:
 Training
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| Recruitment
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 FAQs
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If you are conducting human subject research (or plan to in the future) and can answer Yes to any of the following questions, then HIPAA requirements apply to you.
- Are you using any health information or information that can be linked to or used to identify an individual (e.g. name, address, social security number or other identifier) and pertains to an individual's past, present or future physical or mental health.
- Was the health information obtained as part of clinical care, OR
obtained by someone who normally cares for patients? - Are you conducting retrospective medical chart reviews?
- Are you conducting research using existing biological samples?
- Are you conducting research using existing research or clinical data?
- Are you consenting or re-consenting subjects in an existing research protocol that involves health information after April 14th, 2003?
Carefully read all the documents in the Tool Kit to the right to learn about the requirements to avoid disruption of your research.
When you have completed all applicable forms, please submit them to the appropriate email address listed on the Where do I submit my forms? page.
