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THE OHIO STATE UNIVERSITY AUTHORIZATION TO USE PERSONAL HEALTH INFORMATION IN RESEARCH Title of the Study: Psychometric Properties of the Diagnostic Adaptive Behavior Scale OSU Protocol Number: 2011B0527

How to fill out hipaa research authorization form

How to Fill Out HIPAA Research Authorization Form:

1. Start by obtaining a copy of the HIPAA research authorization form from the appropriate source, such as your healthcare provider or research institution.
2. Carefully read and understand the instructions provided on the form. Familiarize yourself with the purpose and requirements of the authorization.
3. Begin by providing your personal information, such as your full name, date of birth, and contact details. Ensure the accuracy of this information as it will be used to identify you.
4. Indicate the purpose of the authorization by specifying the intended use of your protected health information (PHI) for research purposes.
5. Identify the individuals or organizations that are authorized to receive your PHI. Provide their names, addresses, and any other required contact details.
6. Specify the start and end dates for the authorization period. This will determine the timeframe during which your PHI can be used for research purposes.
7. Review and understand any additional clauses or statements included in the form, such as limitations on the use or disclosure of your PHI.
8. Consider seeking legal advice if you have any doubts or concerns about the content of the form or the implications of signing it.
9. Once you have completed all the necessary sections of the form, sign and date it. By doing so, you are attesting to your understanding and voluntary authorization for the use of your PHI for research purposes.
10. Keep a copy of the filled-out and signed form for your records.

Who Needs HIPAA Research Authorization Form:

1. Individuals who wish to participate in research studies that require access to their protected health information (PHI) typically need to complete a HIPAA research authorization form.
2. Researchers and research institutions that handle PHI must also ensure that they have obtained the necessary authorizations from participants in compliance with HIPAA regulations.
3. Healthcare providers and organizations involved in research activities, including clinical trials or studies, rely on HIPAA research authorization forms to legally access and use individuals' PHI for research endeavors.

For pdfFiller’s FAQs

What is hipaa research authorization form?

HIPAA research authorization form is a document that allows an individual to authorize the use and disclosure of their protected health information 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 individuals conducting research that involves the use of protected health information are required to file a HIPAA research authorization form.

How to fill out hipaa research authorization form?

To fill out a HIPAA research authorization form, one must provide their personal information, the specific purpose of the research, the duration of the authorization, and any relevant restrictions on the use of their health information.

What is the purpose of hipaa research authorization form?

The purpose of the HIPAA research authorization form is to ensure that individuals have control over the use and disclosure of their protected health information for research purposes, while also allowing researchers to access the necessary information.

What information must be reported on hipaa research authorization form?

The HIPAA research authorization form must include the individual's name, contact information, details of the research project, a description of the protected health information being used, and any limitations or restrictions on the disclosure of the information.

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