Instructions for Completing the NEW HIPAA for Research Purchases.
Creighton HIPAA Authorization Template for Research *NEW*
The HIPAA for Research Purposes has been revised and simplified. Submitters are instructed to:
1. Complete the study-specific information at the top of page one (Study Title, IRB Number, PI, etc.).
2. Update the bulleted information in RED on page one as appropriate to your study. Remove CHI Health if CHI is not involved in your study, add the name of the study sponsor if your protocol is funded, and add the names(s) of other partnering institutions as necessary.
3. Check the appropriate box on page three regarding release of medical records. Please read the options carefully.
4. Make no additional edits or changes to the form.
If you have questions about completing the form, please call the Research Compliance Office at 402-208.2126.
