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HIPAA Documents
  • SUNY New Paltz policy and procedure on research subjects' right to privacy *
  • HIPAA introduction *
  • Model forms for use by covered entities [ PDF or Word]
  • HIPAA authorization - instructions for preparing consent documents for HIPAA compliance *
  • Attachment A* - What about confidentiality of records and authorization to use/share protected health information for research? [ PDF or Word]
  • Attachment B* - Consent language for banking specimens or voice/fingerprints in research [ PDF or Word]
  • Attachment C* - Consent to participate in research and authorization to use and share personal health information [ PDF or Word]
  • Attachment D* - Consent to participate in research and authorization to use and share personal health information (for subjects 18 years of age and older) [ PDF or Word]
  • Attachment E* - Consent to participate in research and authorization to use and share personal health information (for subjects less than 18 years of age) [ PDF or Word]
  • Application for HIPAA waiver of authorization [ PDF or Word]
  • HIPAA de-identification certification form [ PDF or Word]
  • Limited data set (LDS) request form [ PDF or Word]
  • Model data use agreement [PDF or Word]
  • Model request for permission to access identifiable health information of deceased individuals [ PDF or Word]
  • Model request for permission to access identifiable health information for reviews preparatory to research [ PDF or Word]