Institutional Review Board

HIPAA FORMS

NOTE:  If the study involves performance sites external to LSUHSC, such as the LSU Healthcare Network, UMC, and OLOL, please make sure to use the appropriate joint HIPAA authorization form. If no joint form exists for the external institution, please use the standard LSUHSC HIPAA form or contact the IRB Office at IRBOffice@lsuhsc.edu.  

DOCUMENT ID TITLE VERSION #
HRP-2652 HIPAA Data Guidance 3.0
HRP-2210 LSUHSC HIPAA Authorization Form (English) 4.2
HRP-2210 LSUHSC HIPAA Authorization Form (French) 4.2
HRP-2210 LSUHSC HIPAA Authorization Form (Spanish) 4.2
HRP-2210 LSUHSC HIPAA Authorization Form (Vietnamese) 4.2
  LSUHSC-CHNOLA Joint HIPAA Authorization Form (English) 7.2020
  LSUHSC-CHNOLA Joint HIPAA Authorization Form (Spanish)  7.2020
HRP-2210HN LSUHSC-LSUHN Joint HIPAA Authorization Form (English) 4.2
HRP-2210HN LSUHSC-LSUHN Joint HIPAA Authorization Form (French) 4.0
HRP-2210HN LSUHSC-LSUHN Joint HIPAA Authorization Form (Spanish) 4.0
HRP-2210HN LSUHSC-LSUHN Joint HIPAA Authorization Form (Vietnamese) 4.0
HRP-2210OLOL LSUHSC-OLOL Joint HIPAA Authorization Form (English) 2.1
HRP-2210UMC LSUHSC-UMC Joint HIPAA Authorization Form (English) 2.1
HRP-2210UMC LSUHSC-UMC Joint HIPAA Authorization Form (French) 2.0
HRP-2210UMC LSUHSC-UMC Joint HIPAA Authorization Form (Spanish) 2.0
HRP-2210UMC LSUHSC-UMC Joint HIPAA Authorization Form (Vietnamese) 2.0
HRP-2213 LSUHSC Verbal HIPAA Authorization Form (English) 1.0
HRP-2213.1 LSUHSC Verbal HIPAA Authorization Script (English) 1.0