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-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 |
| 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 |