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This document is a request form used by Clinical Research Associates or study team members at SUNY Upstate Medical University to obtain access to identifiable patient information for research purposes,

How to fill out request for access to

How to fill out Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes

1. Obtain the Request for Access form from the relevant health information authority or organization.
2. Carefully read the instructions provided with the form to understand the requirements.
3. Fill out your personal information, including name, address, and contact details.
4. Specify the purpose for accessing the IIHI, clearly stating that it is for research purposes.
5. Detail the specific data you wish to access, including any relevant time frames or conditions.
6. Include any necessary institutional affiliations and ethical approvals related to your research.
7. Sign and date the form to certify that the information provided is accurate and complete.
8. Submit the completed form to the designated authority, either electronically or by mail, as specified.

Who needs Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes?

1. Researchers conducting studies requiring access to electronic individually identifiable health information.
2. Academic institutions seeking health data for scientific research and analysis.
3. Public health officials needing data for health assessments and program evaluation.
4. Government agencies involved in health research and policy-making.

People Also Ask about

What language is a HIPAA authorization in?

HIPAA Authorization Defined An authorization must be in writing, written in plain language, and must contain specific elements and statements to be valid.

What is a HIPAA authorization for research purposes?

A Privacy Rule Authorization is an individual's signed permission to allow a covered entity to use or disclose the individual's protected health information (PHI) that is described in the Authorization for the purpose(s) and to the recipient(s) stated in the Authorization.

What is an example of individually identifiable health information?

Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

What is IIHI in HIPAA?

Health and fitness apps: Data collected by or entered into a mobile fitness or health app is not PHI. De-identified PHI: Health data that has had all personal identifiers removed and cannot be linked to a specific individual is no longer considered PHI.

Is IIHI protected by HIPAA?

ing to HIPAA, Protected Health Information includes IIHI that is: Transmitted by electronic media (e.g. sent through email), Maintained in electronic media (e.g. stored on a server), or. Transmitted or maintained in any other form or medium (including paper documents stored in physical locations).

What kind of health information is not protected by HIPAA?

The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."

Is all PHI protected by HIPAA?

if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.

For pdfFiller’s FAQs

What is Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes?

It is a formal application submitted by researchers to obtain access to electronic health information that can identify individuals, to be used for research studies while ensuring the protection of patient confidentiality and compliance with privacy regulations.

Who is required to file Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes?

Researchers, academic institutions, and organizations conducting studies that require access to electronic IIHI must file this request to ensure legal and ethical compliance in handling sensitive health information.

How to fill out Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes?

To fill out the request, provide details such as the research title, purpose, methodology, a description of the data needed, how data will be used, and measures for data protection. Submit the completed form along with any required documents to the designated review board.

What is the purpose of Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes?

The purpose is to facilitate the collection of essential health data for research while safeguarding patient privacy, ensuring that researchers have a legal framework for accessing sensitive information to improve healthcare outcomes.

What information must be reported on Request for Access to Electronic Individually Identifiable Health Information (IIHI) for Research Purposes?

The request must report the research objectives, data types required, research methodology, data security measures, expected outcomes, potential risks to subjects, and how compliance with ethical standards will be maintained.