Login to MyChart

Help us elevate and expand our care, make breakthroughs in biomedical science and improve community health and wellness.

Donate today

Search UVM Health

Data Access for Review Preparatory to Research

  1. Home
  2. Data Access for Review Preparatory to Research
Data Access for Review Preparatory to Research

The purpose of this memorandum is to clarify your recent request for access to protected health information (PHI) for a review preparatory to research. In order to honor your request, each of the following statements must apply to your proposed research:

Image for prep to research IRB form
Indicate below the PHI identifiers, as defined by HIPAA, that will be included in the Data Set:

I hereby request access for review preparatory to research and attest to the following:

  1. The use of disclosure of the PHI is solely for preparatory to research.
  2. The requested PHI is necessary to prepare for research.
  3. The PHI will not be further used or disclosed unless appropriate authorizations have been obtained. 

If you have any questions or require assistance completing this form, email Data.Governance@UVMHealth.org or contact the UVMH Compliance & Privacy Office at 802-847-2667 or Compliance@UVMHealth.org.
844-UVM-HEALTH

Give to a Healthier Future

Help us elevate and expand our care, make breakthroughs in biomedical science and improve community health and wellness.

Healthier communities. Healthiest lives. Together.

University of Vermont Medical Center

111 Colchester Ave
Burlington, VT 05401

802-847-0000

Golisano Children's Hospital

111 Colchester Ave
Burlington, VT 05401

802-847-0000

Central Vermont Medical Center

130 Fisher Road
Berlin, VT 05602

802-371-4100

Champlain Valley Physicians Hospital

75 Beekman Street
Plattsburgh, NY 12901

518-561-2000

Elizabethtown Community Hospital

75 Park Street
Elizabethtown, NY 12932

518-873-6377

Alice Hyde Medical Center

133 Park Street
Malone, NY 12953

518-483-3000

Porter Medical Center

115 Porter Drive
Middlebury, VT 05753

802-388-4701

Home Health & Hospice

1110 Prim Road
Colchester, VT 05446

802-658-1900

© 2026 University of Vermont Health