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DEPARTMENT OF HEALTH SERVICES Division of Care and Treatment Services F24277 (09/2016)STATE OF WISCONSIN 42 CFR483.420(a)(2) DHS 134.31(3)(o) DHS 94.03 & 94.09 51.61(1)(g) & (h)INFORMED CONSENT FOR
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Individuals who are required to provide consent for a specific purpose, such as medical treatments, research participation, or data sharing.
02
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03
Parents or legal guardians who need to provide consent on behalf of minors or individuals lacking decision-making capacity.
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This consent is maintained to ensure that individuals have given their permission for their personal information to be collected, used, and stored.
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The purpose of this consent is maintained is to protect individuals' privacy rights and ensure that their personal information is handled responsibly and in accordance with data protection regulations.
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The information that must be reported on this consent is maintained includes the individual's name, contact details, the specific purposes for collecting their data, and the date when consent was obtained.
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