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DREXEL UNIVERSITY COLLEGE OF MEDICINE Consent and Release Form for Use of Protected Health Information 1. General Description. Thank you for agreeing to our request to participate in the education

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How to fill out consent and release form

01

Start by writing the title of the consent and release form at the top of the document.

02

Include a brief introductory statement explaining the purpose and scope of the form.

03

Clearly state the name and contact information of the person or organization seeking consent.

04

Provide a section for the participant's personal information, including name, address, and contact details.

05

Specify the activities or events for which the consent is required.

06

Clearly explain the nature of the consent being given and any potential risks or hazards involved.

07

Include a section for the participant to authorize the use and disclosure of their personal information for specific purposes.

08

Clearly outline the rights and responsibilities of both the participant and the person or organization seeking consent.

09

Include a section for the participant to sign and date the form, indicating their understanding and agreement with the terms.

10

Provide space for a witness to also sign and date the form, if necessary.

11

Make sure to keep a copy of the completed form for your records.

12

Review the completed form with the participant to ensure they understand its contents before proceeding.

Who needs consent and release form?

01

Anyone who wishes to obtain consent for activities or events involving others needs a consent and release form.

02

This can include organizations planning events, companies conducting research studies, schools organizing field trips, or photographers capturing images of individuals.

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What is consent and release form?

A consent and release form is a legal document that grants permission for the use of an individual's likeness, voice, or other personal information in specific circumstances.

Who is required to file consent and release form?

Any individual or organization that wants to use someone's likeness, voice, or personal information in a specific way may be required to file a consent and release form.

How to fill out consent and release form?

To fill out a consent and release form, one must provide their personal information, specify the intended use of their likeness or personal information, and sign the document to indicate their consent.

What is the purpose of consent and release form?

The purpose of a consent and release form is to ensure that individuals have given their informed consent for the use of their likeness, voice, or personal information in specific circumstances.

What information must be reported on consent and release form?

The consent and release form typically requires information such as the individual's name, contact information, a description of the intended use, and the duration of consent.

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