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Privacy Board

The Privacy and Civil Liberties Office (PCLO) established a Health Insurance Portability and Accountability Act (HIPAA) Privacy Board, otherwise known as the DHA Privacy Board, to provide HIPAA Privacy Rule reviews and documentation for researchers that seek to use and/or disclose protected health information (PHI) managed by DHA. The DHA Privacy Board is critical for DHA’s compliance with the HIPAA Privacy Rule (45 CFR 160 & 164) and Department of Defense (DOD) Health Information Privacy Regulation (DOD 6025.18-R).

More information on the establishment of the DHA Privacy Board can be found here: Memorandum for the Establishment of a TMA Privacy Board and Revision of Section C7.9.1 of Department of Defense (DOD) Health Information Privacy Regulation (DOD 6025.18-R).

Privacy Board Annual Report

The DHA Privacy Board releases an Annual Report each calendar year, highlighting the achievements of the Board, providing information about the direction of the Board in the upcoming year, and acknowledging the Board members who volunteer both expertise and time to the effort of the DHA Privacy Board. The most recent annual report is accessible below:

Board Members

As required by the HIPAA Privacy Rule and DOD Health Information Privacy Regulation (DOD 6025.18-R), the DHA Privacy Board:

  • Has members of varying and appropriate professional competency as necessary to review the effect of the research protocol on the individual’s privacy rights and related interests
  • Includes at least one member who is not affiliated with the HIPAA covered entity (DHA within the Military Health System), not affiliated with any entity conducting or sponsoring the research, and not related to any person who is affiliated with any of such entities
  • Does not have any member participating in a review of any project in which the member has a conflict of interest

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Form/Template
Aug 1, 2012

Required Representations for Review Preparatory to Research

.PDF | 1.63 MB

Use this form if the researcher intends to conduct a review of PHI to prepare for a research protocol or for similar purposes preparatory to research (e.g., for recruitment or screening purposes) and agrees not to remove the PHI from DHA, the PI may submit this template to document the required representations, as outlined above, that are necessary ...

Form/Template
Aug 1, 2012

Principal Investigator Certification

.PDF | 1.73 MB

Use this form if a Research Authorization Review template and an Authorization are approved by the DHA Privacy Board, a Principal Investigator (PI) will be required to sign a Principal Investigator Certification. Among other requirements, the certification ensures that the PI will maintain, electronically and/or in hard copy, the signed Authorization ...

Form/Template
Aug 1, 2012

Research Authorization Review

.PDF | 1.60 MB

Use this form if the researcher intends to obtain HIPAA Authorizations, also known as “Authorizations,” from research participants to comply with the HIPAA Privacy Rule, the PI must submit to the DHA Privacy Board a copy of the blank Authorization(s) to be used in the project and the completed Research Authorization Review. The DHA Privacy Board will ...

Form/Template
Aug 1, 2012

Required Representations for Research on Decedents Information

.PDF | 507.64 KB

Use this form if the researcher intends to conduct research that is solely on the protected health information (PHI) of decedents, the PI may submit this template to document the required representations, as outlined above, that are necessary for compliance with the HIPAA Privacy Rule and Department of Defense (DOD) Health Information Privacy ...

Form/Template
Aug 1, 2012

DHA Privacy Board Application for a Waiver of Authorization or an Altered Authorization

.PDF | 1.57 MB

Use this form if the researcher has not received documentation from an Institutional Review Board (IRB) or HIPAA Privacy Board approving a waiver or alteration of Authorizations and reasons exist that make it impractical or impossible for the researcher to obtain Authorizations from each research participant, the PI may submit an Application for a ...

Last Updated: March 25, 2024
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