Please access and use the following forms in iRIS under My Assistant / Operating Procedures when submitting a new study application in iRIS.
Research Privacy Forms (1-4):
1 -Authorization To Use or Disclose PHI
Used for most clinical
research projects not involving psychotherapy
or repository research.
Form 1 -Spanish translated version
2 -Authorization To Use or Disclose Psychotherapy Notes for Research
Instructions (click here) -for preparing the authorization for disclosure of psychotherapy notes
Form 2 -Spanish translated version
3 -Authorization To Use or Disclose PHI for Repository Research
For repository research only.
Form 3 -Spanish translated version
4 -Authorization To Use or Disclose PHI for Research That Also Includes Repository Research
Combination of Forms 1 & 3. Used for combined research
that includes repository research.
Form 4 -Spanish translated version
Research Privacy Form (OKC-VAMC):
OKC-VAMC Authorization for Release of PHI for Research
Research Privacy Form (5):
Form 5 -Request for Waiver or Alteration to Use or Disclosure of PHI in Research
Research Privacy Forms (6-10):
6 -Investigator Representation for Review of PHI- Preparatory to Research
Used only to determine if
research can be conducted. Is not for patient screening.
7 -Investigator Representation for Research on PHI of Decedents
8 -Investigator Representation for Research on De-identified PHI
9 -Investigator Representation for Research on Limited Data Sets of PHI
10 -Data Use Agreement For a Limited Data Set
For use with Form 9,
Research Privacy Form (Tulsa):
St. Francis Hospital-Authorization For Use and/or Disclosure of Individual PHI For Research Purposes