Forms and Documents
Research HIPAA Compliance provides forms and documents to help researchers using public health information data. Please contact the UMCIRB if you cannot find the appropriate form for your research.
General ECU and Vidant HIPAA Information
- HIPAA Identifiers (PDF)
- HIPAA Decision Tree – Does HIPAA Apply to Your Human Research Activities at ECU? (PDF)
- ECU Health Care Components (PDF)
- Vidant Health Care Components (PDF)
Limited Data Set Policies
- ECU HIPAA Privacy Manual: Limited Data Set (Section 2.1.9)
- Vidant Health Policy and Procedure: Disclosure of a Limited Data Set (PDF)
HIPAA Forms
- HIPAA Authorization Template (Word)
- HIPAA Authorization Template-Spanish Version (Word)
- HIPAA Authorization-Future Research (Word)
- HIPAA Authorization-Future Research-Spanish Version (Word)
- Parent HIPAA Authorization for Minor Participants (Word)
- Application for Waiver or Alteration of HIPAA Authorization (PDF)
- Application for Waiver or Alteration of HIPAA Authorization (Word)
- Research on Decedents Information Form (Word)
- Request-for-Preparatory-Review-of-PHI (Word)
Information Technology Security
