Contact Information

206.667.5900

Mailing address:
Fred Hutch Cancer Center
Institutional Review Office
1100 Fairview Ave. N.
Mail Stop J2-100
Seattle, WA 98109

Contact Information

Last Modified: 05-05-25

HIPAA Authorization for the Use of Patient Information for Research

The purpose of this template is to create the HIPAA Authorization form that participants, parents, and/or legally authorized representatives of participants sign to give researchers permission to obtain and use their protected health information (PHI) for research purposes. See instructions on the first page.  This template is approved by both Fred Hutch and UW Medicine.

HIPAA Authorization for the Use of Patient Information for Research