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AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION FOR RESEARCH TO THIRD PARTY RESEARCHER Title of Research Project: Purpose of Research Project: Patient Name: Date of Birth: Principal
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Third party researcher refers to an external individual or organization that conducts research on behalf of another entity.
The entity or organization that has engaged the third party researcher is required to file.
The form to report to a third party researcher can typically be filled out online or through a physical paper form provided by the relevant authority.
The purpose of reporting to a third party researcher is to ensure transparency and accountability in research activities conducted on behalf of an entity.
Information such as the name of the third party researcher, the research project being conducted, the funding source, and any potential conflicts of interest must be reported.
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