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Human Subjects Division (HSD)


Document Details

Last Updated 04/24/2015
Version 3.50
Filesize 122.5 KB
Audiences Researcher
Doc Type Template

TEMPLATE: HIPAA Authorization


The purposed of this template is to create the HIPAA Authorization form that subjects, parents, and/or legally-authorized representatives of subjects sign to give you permission to obtain and use protected health information (PHI) of subjects for research purposes.

Change Notes

  • Related to Ver. 3.40, noted 10/19/2013 @ 04:59pm
    Updated name to new naming convention on website.
    - sherrye
  • Related to Ver. 3.40, noted 01/10/2011 @ 11:22am
    HSD address removed from header.
    - sherrye