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Practice makes perfect: Uniformed Services University students learn combat casualty care
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Form/Template
7/1/2013
Use this form to bill for cosmetic surgery.
Form/Template
8/1/2012
Use this form if a Research Authorization Review template and an Authorization are approved by the DHA Privacy Board, a Principal Investigator (PI) will be required to sign a Principal Investigator Certification. Among other requirements, the certification ensures that the PI will maintain, electronically and/or in hard copy, the signed Authorization for each research participant whose PHI is used or disclosed in the project, and will provide any and/or all of the signed Authorizations to DHA immediately upon request.
Recommended Content:
Privacy Board
Form/Template
8/1/2012
Use this form if the researcher has not received documentation from an Institutional Review Board (IRB) or HIPAA Privacy Board approving a waiver or alteration of Authorizations and reasons exist that make it impractical or impossible for the researcher to obtain Authorizations from each research participant, the PI may submit an Application for a Waiver of Authorization or an Altered Authorization. A DHA Privacy Board member will conduct an expedited review of the completed application and determine whether to approve or deny an altered Authorization or a full or partial waiver of Authorizations.
Recommended Content:
Privacy Board
Form/Template
8/1/2012
Use this form if the researcher intends to obtain HIPAA Authorizations, also known as “Authorizations,” from research participants to comply with the HIPAA Privacy Rule, the PI must submit to the DHA Privacy Board a copy of the blank Authorization(s) to be used in the project and the completed Research Authorization Review. The DHA Privacy Board will conduct a review to determine that all core elements and required statements are provided in the Authorization(s) as required by the HIPAA Privacy Rule and DOD 6025.18-R.
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Privacy Board
Form/Template
8/1/2012
Use this form if the researcher intends to conduct research that is solely on the protected health information (PHI) of decedents, the PI may submit this template to document the required representations, as outlined above, that are necessary for compliance with the HIPAA Privacy Rule and Department of Defense (DOD) Health Information Privacy Regulation (DOD 6025.18-R).
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Privacy Board
Form/Template
8/1/2012
Use this form if the researcher intends to conduct a review of PHI to prepare for a research protocol or for similar purposes preparatory to research (e.g., for recruitment or screening purposes) and agrees not to remove the PHI from DHA, the PI may submit this template to document the required representations, as outlined above, that are necessary for compliance with the HIPAA Privacy Rule and DOD 6025.18-R.
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Privacy Board
Form/Template
2/1/2012
Use this form to request a copy of your mitochondrial DNA type to help recover family member remains.
Form/Template
8/10/2011
This form should be completed and signed by the prescriber to request prior authorization to use a brand name drug instead of a generic equivalent.
Form/Template
3/29/2011
This form is a tool that can be used when a collaborating investigator is not part of an institution with a federal assurance.
Form/Template
3/8/2011
Use this form to grant permission to the Armed Forces Medical Examiner System to retain organs for an extended examination to determine cause of death.
Form/Template
8/30/2010
This form should be used when an institution will be engaged in human subject research and will use an Institutional Review Board (IRB) that is not organizationally or legally part of the institution.
Form/Template
4/16/2010
Use this worksheet when referring a service member under the Supplemental Health Care Program.
Form/Template
8/20/2009
This form is a tool to help Institutions with an existing FWA approved by DHHS to know about and acknowledge key DOD policies and requirements since the DHHS FWA does not identify DOD requirements.
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Last Updated: July 20, 2022