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HIPAA Forms

These are standards forms and guidelines for HIPAA. DO NOT ALTER THE TEXT THAT IS EMBEDDED IN THESE DOCUMENTS. Simply insert at the designated spaces the responses to the information on the template. Once completed, Submit to the IRB office for approval.

• HIPAA Compliance Application
• Record, Chart Review, or Computer Database Research
• Request for Discarded/Stored Human Biological Specimens
• Application for Waiver of Authorization
• PI Attestation - Research using Decedent Information
• Revocation Letter
• Data use Agreement

Consent Templates

Templates are all Word Documents.

• Elements of Consent


• Biomedical


• Behavioral


• Oncology NCI Consent


• Assent for Minors


• You/Your Child


• Bill of Rights


• Bill of Rights in Spanish


• HIV Wording

COI Form

The Research Institute Conflict of Interest policies regarding disclosures have not changed, so you are being asked to reveal any "financial interests which may compromise or have the appearance of compromising an investigator's professional judgment in conducting or reporting research". You must disclose your relevant financial interests as well as those of your spouse, your domestic partner or your dependent children.

COI Form


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