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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):                 

Form 1 -Authorization To Use or Disclose PHI                                 

 Used for most clinical research projects not involving psychotherapy or repository research.

 Form 1 -Spanish translated version                                                           

 

Form 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   

 

Form 3 -Authorization To Use or Disclose PHI for Repository Research

 For repository research only.

 Form 3 -Spanish translated version   

 

Form 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):

Form 6 -Investigator Representation for Review of PHI- Preparatory to Research 

 Used only to determine if research can be conducted. Is not for patient screening.

 

Form 7 -Investigator Representation for Research on PHI of Decedents

 

Form 8 -Investigator Representation for Research on De-identified PHI

 

Form 9 -Investigator Representation for Research on Limited Data Sets of PHI

 

Form 10 -Data Use Agreement For a Limited Data Set 

    For use with Form 9, as appropriate.  

 

Research Privacy Form (Tulsa):

St. Francis Hospital-Authorization For Use and/or Disclosure of Individual PHI For Research Purposes

 

Institutional Review Board (IRB) - OU Health Sciences Center
Library Building, Room 176
Phone: 405/271-2045 - Fax: 405/271-1677
IRB@ouhsc.edu

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