HIPAA RESEARCH PRIVACY OFFICER
Mo Valentine, M.P.A.
Director, Institutional Review Board
University of Arkansas for Medical Sciences
4301 W. Markham St., Slot 812
Little Rock, AR 72205-7199, USA
Phone: (501) 526-7559
Fax: (501) 686-7265
E-mail: valentinepamelam@uams.edu

Medical Record Request Form (MS Word)
This form must be filled out for presentation to Medical Records at the time of the request for information.

OTHER FORMS AND INFORMATION
UAMS HIPAA Research Policy (MS Word)

UAMS De-Identification Chart (PDF)

HIPAA for Research Training

HIPAA Privacy Rule -- Information for Researchers

HIPAA Authorization (MS Word)

HIPAA Data Use Agreement Template (MS Word)

HIPAA Review Preparatory to Research Attestation (MS Word)

HIPAA Research on the Deceased Attestation (MS Word)