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HIPAA Guide & Forms

The Health Insurance Portability and Accountability Act (HIPAA) is a new federal law that protects patients from disclosure of Private Health Information (PHI) to third parties. Research that involves access to any patient records or other private health information is covered under this act. All SIUE faculty, staff, and students conducting research that may use health information must comply with these regulations.

Research can comply with these regulations in a number of ways. The two most common are to receive authorization directly from subjects of the study or to request a waiver. For research that requires subject authorization, you can use the link below to download a sample HIPAA Authorization form as a Microsoft Word document which can be modified appropriately for your study. A signed Authorization form must be obtained from any subject used in the study. A copy of your Authorization form must be submitted along with your IRB protocol and be approved by the University IRB before data collection can begin.

Download HIPAA Authorization Form

In cases where the disclosure of health information would result in minimal risk to the subject, the project director may request a waiver of subject authorization. You can use the link below to download a sample HIPPA Waiver form as a Microsoft Word document, which can be modified appropriately for your study. A copy of your Waiver form must be submitted along with your IRB protocol and be approved by the University IRB before data collection can begin.

Download HIPAA Waiver Form

Download Examples of PHI Identifiers

Download HIPAA De-Identification Form

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