HIPAA Forms - Wichita Medical Research and Education Foundation

To enhance medical knowledge and skills through the advancement of research and education

Wichita Medical Research & Education Foundation

Please click on the links below to download HIPAA Forms.

WMREF Authorization for Disclosure

WMREF Checklist for Authorization to Use and Disclose PHI for Research Purposes Review

WMREF Application for IRB Waiver of Authorization

WMREF IRB De-Identification Certification Form

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Medical Research is not a solitary endeavor. Your gift of: membership dues, endowment gifts; memorials; bequests provides many opportunities for us to gain knowledge to improve the chances for all of us to live longer, happier, healthier lives. Contact Peggy L Johnson, Executive Director, 316-686-7172.

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