HIPAA Manual

Effective Date: April 14, 2003

Without Appendices

• PDF | Word

Appendices

• Appendix A PDF | Word
  Authorization to Permit the Use & Disclosure of Protected Health Information for Research Purposes Addendum to Research Consent Form
• Appendix B PDF | Word
  Honest Broker Certification Process Related to the De-identification of Health Information for Research and Other Duties/Requirements of an Honest Broker
• Appendix C PDF | Word
  Application for the Certification of Honest Broker Systems/Processes
• Appendix D PDF | Word
  Business Associate Agreement for Honest Brokers
• Appendix E PDF | Word
  Application to Honest Broker to Create a De-identified Data or Limited Data Set
• Appendix F PDF | Word
  Application for IRB Waiver of HIPAA Privacy Authorization
• Appendix G PDF | Word
  Data Use Agreement for Limited Data Sets
• Appendix H PDF | Word
  Revocation of Authorization for Use or Disclosure of Health Information for Research Purposes
• Appendix I PDF | Word
  Agreement for Record Review Prepatory to Research
• Appendix J PDF | Word
  Application for Research Involving Only Decedents' Information
• Appendix K PDF | Word
  Authorization for the Sharing of Health Information Related to Possible Participation in a Research Study
• Appendix L PDF | Word
  Consent to Act as a Participant in a Research Registry
• Appendix M PDF | Word
  Sample Research Registry Protocol
• Appendix N - Form PDF | Word
  Accounting Form for Disclosures as Required or Authorized by Law
• Appendix N - -49 PDF | Word
  Accounting Form - Research Involving Disclosures About 49 or Fewer Individuals
• Appendix N - multi -49 PDF | Word
  Accounting Form - Research Involving Multiple Disclosures About an Individual to the Same Person in a Research Study Involving 49 or Fewer Individuals
• Appendix N - +50 PDF | Word
  Accounting Form - Research Involving Disclosures About 50 or More Individuals