№ lp_1_14870
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This document is a template for creating the HIPAA Authorization form required for participants to provide permission for the use of their protected health information in research studies.
Year: N/A
Region / City: N/A
Theme: Research, Health Information, HIPAA Authorization
Document Type: Template
Organization / Institution: UW Medicine, Fred Hutchinson Cancer Center
Author: N/A
Target Audience: Research Participants, Legal Representatives
Effective Period: N/A
Approval Date: N/A
Revision Date: N/A
Price: 8 / 10 USD
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Research Consent Form and HIPAA Authorization
Note: Year
Topic: Research
Document Type: Consent Form
HIPAA Authorization Waiver Request Form for Research
Note: Version Date
HIPAA Final Rule 2013HITECH & Business Associates
Year: 2013
Region / City: United States
Topic: Health Information Privacy
Document Type: Regulatory Guidelines
Organization / Institution: Department of Health & Human Services
Author: Department of Health & Human Services
Target Audience: Covered entities, business associates, legal professionals
Period of Validity: Ongoing
Approval Date: January 25, 2013
Amendment Date: Not specified
HIPAA Business Associate Agreement
Note: Year
Topic: Business Associate Agreement, HIPAA Compliance
Document Type: Agreement
HIPAA Notice of Privacy Practices
Year: 2026
Region / City: United States
Subject: Health information privacy
Document type: Privacy notice
Organization: Physician practice
Author: Privacy Officer
Effective date: [insert effective date]
Legal reference: 45 C.F.R. § 164.520
Target audience: Patients
Rights covered: Access, amendment, accounting of disclosures, confidential communications, special privacy protections
Consent to be a Research Subject and HIPAA Authorization
Note: Year
HIPAA Business Associate Agreement
Year: 2023
Region / City: United States
Topic: Health Information Privacy
Document Type: Agreement Template
Organ / Institution: The HIPAA Journal
Author: The HIPAA Journal
Target Audience: Businesses handling Protected Health Information
Effective Date: [Effective Date]
Date of Changes: [Date of Changes]
Partnership HealthPlan of California HIPAA Transaction Companion Guide CORE: 276/277 Health Care Claim Status Request and Response ASC X12 version 005010 Disclosure Statement
Note: Year
University of PennsylvaniaRESEARCH PARTICIPANTInformed Consent and HIPAA AUTHORIZATION Form
Year: 2023
Region / City: Philadelphia
Topic: Research Consent Form
Document Type: Informed Consent
Institution: University of Pennsylvania
Author: University of Pennsylvania Research Team
Target Audience: Potential research participants
Study Duration: Variable
Approval Date: Not specified
Amendment Date: Not specified
HIPAA Transaction Standard Companion Guide 835 (ERA) Electronic Remittance Advice Health Care Claim Payment/Advice
Year: 2024
Region / City: United States
Topic: Health Care, HIPAA Compliance, Electronic Transactions
Document Type: Companion Guide
Organization: UCare
Author: UCare
Target Audience: Health care providers, trading partners, billing services, software vendors, financial institutions
Period of Action: 2024
Approval Date: 11/01/2024
Date of Modifications: Not specified
Research Consent Form and HIPAA Authorization
Note: Year
LSUHSC-NO/UMCNO CONSENT AND HIPAA AUTHORIZATION TEMPLATE
Note: Year
SAMPLE INDIVIDUAL HIPAA BREACH NOTICE LETTER
Year: 2016
Region / City: Portland, OR
Topic: Privacy / Data Protection
Document Type: Letter
Organization: OHCA
Author: Not specified
Target Audience: Individuals whose personal data may have been breached
Effective Period: Not specified
Approval Date: July 26, 2016
Modification Date: Not specified
HIPAA Authorization to Disclose Protected Health Information and Consent for Publication of Photos, Videos, and Other Identifying Materials
Note: Year
Theme: Healthcare, Legal, Medical Records
Document Type: Authorization Form
Organization / Institution: American Academy of Dermatology, JAAD International
Target Audience: Patients, Legal Representatives
HIPAA Privacy Forms
Year: 2023
Region / City: USA
Theme: Health Information Privacy
Document Type: Forms
Organization / Institution: American Medical Association
Author: American Medical Association
Target Audience: Healthcare providers, medical practitioners
Effective Period: N/A
Approval Date: N/A
Amendment Date: N/A
Durable Medical Equipment Authorization Request
Note: Year
Organization / Institution: U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation
Authorization and Invoice for Medical and Hospital Services
Year: 2023
Region / City: United States
Topic: Medical authorization and billing
Document type: Official form
Organization / Institution: Department of Veterans Affairs
Author: Department of Veterans Affairs
Target audience: Healthcare providers, Veterans
Period of validity: From date of issue
Date of approval: Not specified
Date of amendments: Not specified
Certification Letter for Proposal Submission and Authorization to Release Information
Year: 2023
Region / City: Iowa, Des Moines
Subject: Proposal Certification and Authorization to Release Information
Document Type: Certification Letter
Issuing Organization: Iowa Workforce Development
Author: Michael Drottz
Target Audience: Respondents to RFP 309MD24001
Period of Validity: N/A
Approval Date: N/A
Date of Revision: N/A
Access Authorization: Early Education Student – Superintendent Authorization
Note: Year
Organization / Institution: Minnesota Department of Education
Target Audience: School District Superintendents, Early Education Staff
Certification and Authorization for Release of Information
Year: 2023
Region / City: United States
Topic: Personnel vetting, security clearance
Document Type: Questionnaire, Authorization Form
Agency: Federal Government
Author: Unknown
Target Audience: Individuals undergoing personnel vetting
Period of Validity: Until termination of affiliation with the Federal Government or position requirement
Approval Date: Not specified
Amendment Date: Not specified
Topics: HIPAA Authorization Instructions