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This form is required to obtain authorization from research subjects at Ohio State University for the use and sharing of their protected health information (PHI) during research studies in compliance

How to fill out hipaa research authorization form

How to fill out HIPAA RESEARCH AUTHORIZATION FORM

1. Begin by filling out the patient's name and contact information at the top of the form.
2. Provide a detailed description of the research study, including purpose, procedures, and who will be conducting the research.
3. Clearly specify what health information will be used or disclosed for the research.
4. Indicate the individuals or organizations authorized to use or disclose the information.
5. Include the duration of the authorization, stating how long the patient's information may be used or disclosed.
6. Ensure to specify if the information will be shared with any third parties and the context of this sharing.
7. Provide options for the patient to revoke the authorization at any time and describe how they can do this.
8. Ensure the patient understands their rights under HIPAA by including a statement about their rights to access and amend their health information.
9. Include a signature section for the patient, along with the date signed and a section for the witness if required.
10. Review the completed form for any errors or omissions before submission.

Who needs HIPAA RESEARCH AUTHORIZATION FORM?

1. Researchers conducting studies involving health information.
2. Institutional Review Boards (IRBs) overseeing the ethical conduct of research.
3. Healthcare providers involved in the research who need to access patient health information.
4. Patients participating in research studies to understand how their information will be used.

For pdfFiller’s FAQs

What is HIPAA RESEARCH AUTHORIZATION FORM?

The HIPAA Research Authorization Form is a document that allows researchers to obtain permission from individuals to use or disclose their protected health information (PHI) for research purposes in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

Who is required to file HIPAA RESEARCH AUTHORIZATION FORM?

Researchers and institutions conducting studies that involve the use of protected health information must obtain a signed HIPAA Research Authorization Form from participants before using their PHI.

How to fill out HIPAA RESEARCH AUTHORIZATION FORM?

To fill out the HIPAA Research Authorization Form, individuals must provide their personal information, describe the research study, specify what information will be used or disclosed, outline who will have access to the information, and indicate the purpose of the research. Additionally, participants must sign and date the form.

What is the purpose of HIPAA RESEARCH AUTHORIZATION FORM?

The purpose of the HIPAA Research Authorization Form is to ensure that individuals are informed about how their health information will be used in research, to protect their privacy, and to comply with legal requirements regarding the use of PHI.

What information must be reported on HIPAA RESEARCH AUTHORIZATION FORM?

The HIPAA Research Authorization Form must report information including the participant's name, description of the research, types of health information to be used, the purpose of the research, the parties involved in the research, and any expiration or cancellation details.