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Human
Investigation Committee
Yale University
School of Medicine
47 College Street,
Suite 204
New Haven, CT
06520-8010 USA


Phone:
(203) 785-4688


Fax:
(203) 785-2847





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YSM - HUMAN INVESTIGATION COMMITTEE.
HIPAA documentation & forms

Guides

Researchers' Guide to HIPAA Privacy

PDF

Web version

Interactive Guide to HIPAA Privacy:
A decision tree for research requirements, access and use of PHI.

 

Interactive version

 

Forms

Data Use Agreement

PDF

Word

Accounting of Disclosures Log

PDF

Internal Data Use Agreement
(For use by Yale University researchers when requesting limited data sets for research purposes from databases and repositories owned by Yale University.)

PDF

Word

Research Authorization Form - Template A.
updated 07-24-09

PDF

Word

 

Research Authorization Form - Template B.
(simpler language/parental permission)
updated 07-24-09

PDF

Word

Research Authorization Form - Template B.
(Spanish version)

PDF

Word

Request for Access to Protected Health Information for a Research Purpose

PDF

Word

Providing Access to Protected Health Information for Research Purposes

PDF

Word

 
  Policies
  Procedures  

 

Visit the HIPAA Web site.

 


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