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**Revised 10/5/2017This consent form template does not contain HIPAA language. ALL consents must contain the appropriate HIPAA language, which can be found at the IRB website on the Forms page. Click
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All consents must contain the agreement of the individual to allow their personal information to be used for a specific purpose.
Any organization or entity that collects and uses personal information is required to file all consents.
All consents must be filled out by providing clear and specific information about how the personal information will be used and obtaining the individual's explicit consent.
The purpose of all consents is to protect the individual's privacy and ensure that their personal information is not misused.
All consents must contain information about the specific purposes for which the personal information will be used, how it will be stored and protected, and how the individual can withdraw their consent.
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