Appendix G Authorization (Permission) to Use or Disclose (Release) Identifiable Health Information for Research

Institutional Review Board: Appendix G - Authorization (Permission) to Use or Disclose (Release) Identifiable Health Information for Research

Below is the Appendix G Authorization (Permission) to Use or Disclose (Release) Identifiable Health Information for Research webform.You will need to scan and save a copy of this paper form that includes the signatures in order to attach it to the webform below. Please note that applicants should provide 12 sets of the entire Institutional Review Board (IRB) application packet to the chairperson for distribution to the board. 

Please refer to the examples listed at http://www.langston.edu/sites/default/files/basic-content-files/Appendix%20G.pdf
Please gather all needed signatures