HSD posts updated documents to the web site on the last Friday of each month. In rare cases, due to an urgent need, an updated document will be posted during the month.
HSD and the IRB ask that researchers make every effort to use the most recent document version.
Questions about a specific document version? Contact hsdforms@uw.edu.
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.
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Purpose
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.