Application for the Disclosure of Protected Health Information
The Application for the Disclosure of Protected Health Information should be completed whenever a study involves the need for the disclosure of protected health information from a covered entity. The HIPAA Application can be accessed electronically through the IRB PHIRST application. A hardcopy of the HIPAA application should only be submitted for modifications to previously approved studies or for those studies seeking approval from WIRB.
Authorization for Protected Health Information
An Authorization for Disclosure of Health Information must be signed by participants for all JHSPH studies where a waiver of the authorization requirement is not obtained, and PHI is accessed from a covered entity pursuant to the participants' agreement. In some cases, a study may need a waiver of the authorization requirement for preliminary access to PHI to determine the eligibility of participants for recruitment purposes, as well as an authorization for PHI obtained from the covered entity pursuant to the participants agreement.
For those studies requiring a hardcopy submission of the HIPAA forms, the applicable HIPAA forms, along with a copy of your Research Plan and consent forms (if applicable) should be submitted to the Office of Graduate Education and Research, Research Compliance Officer, W1033, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, Maryland 21205.
If you have questions about completing the HIPAA forms, please contact Marla Hallacy at firstname.lastname@example.org or 410-502-0433.