Get the free HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes

This document serves as an authorization form required by HIPAA, allowing researchers to access personal health information for the purpose of conducting a research study.

How to fill out hipaa authorization for use

How to fill out HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes

1. Begin by obtaining the HIPAA Authorization form from your research institution or organization.
2. Fill in the participant's name and contact information at the top of the form.
3. Specify the entities or individuals who will use or disclose the health information.
4. Clearly define the purpose of the disclosure, indicating that it is for research purposes.
5. Describe the types of health information that will be disclosed (e.g., medical records, treatment history).
6. Include an expiration date or event that will terminate the authorization.
7. Inform participants about their rights regarding the authorization, including the right to revoke it.
8. Have the participant sign and date the form.

Who needs HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes?

1. Researchers conducting studies that require access to individual health information.
2. Healthcare providers assisting in the research process.
3. Any organization or individual responsible for the management of health information used in research.

People Also Ask about

Should I agree or decline HIPAA authorization?

I hereby authorize use or disclosure of protected health information about me as described below. 4. ​ I understand that the information used or disclosed may be subject to re-disclosure by the person or class of persons or facility receiving it, and would then no longer be protected by federal privacy regulations.

Should I agree or decline HIPAA authorization?

Authorization. A covered entity must obtain the individual's written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.

Is HIPAA authorization required for research?

Research is subject to HIPAA privacy requirements when it is conducted together with the provision of health care information or services. Examples include research involving the review of medical records, or research, (such as surveys), which obtain PHI from patients receiving treatment.

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 does it mean to give HIPAA authorization?

A HIPAA authorization is a detailed document in which specific uses and disclosures of protected health are explained in full. By signing the authorization, an individual is giving consent to have their health information used or disclosed for the reasons stated on the authorization.

For pdfFiller’s FAQs

What is HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes?

HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes is a legal document that allows researchers to obtain access to a patient's protected health information (PHI) for their studies, ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Who is required to file HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes?

Researchers, healthcare institutions, and any party involved in the research process that intends to use or disclose a participant's protected health information must file HIPAA Authorization.

How to fill out HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes?

To fill out the HIPAA Authorization, individuals should provide patient identifiers, specify the information to be used or disclosed, state the purpose of the research, and obtain the participant's signature, ensuring clear understanding of the rights and implications.

What is the purpose of HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes?

The purpose of HIPAA Authorization is to protect patients' privacy by giving them control over who can access their health information, while also allowing vital health data to be used in research that can improve healthcare outcomes.

What information must be reported on HIPAA Authorization for Use and Disclosure of Health Information for Research Purposes?

The information that must be reported includes the specific type and amount of health information to be used or disclosed, the purpose of the disclosure, the expiration date of the authorization, and the individual's rights, including the right to revoke the authorization.