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Approved: 11Nov2016INFORMED CONSENT AND HIPAA AUTHORIZATION FORM FOR SUBJECT
PARTICIPATION IN A RESEARCH STUDY: OPTIONAL BIOLOGICAL SAMPLES
Name of Research Study:A Phase 2b Randomized, Double blind,
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01
Start by reading the consent form carefully to understand the purpose and implications of signing it.
02
Fill out your personal information such as your name, address, date of birth, and contact information.
03
If applicable, provide details about your medical history that may be relevant to the purpose of the consent form.
04
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Submit the consent form to the appropriate party or organization as instructed on the form.
Who needs consent form - upmc?
01
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What is consent form - upmc?
The consent form - upmc is a document that allows an individual to give permission for their personal information to be used or shared by UPMC for various purposes.
Who is required to file consent form - upmc?
All patients or individuals who are receiving medical treatment or services from UPMC are required to file a consent form.
How to fill out consent form - upmc?
To fill out the consent form - upmc, individuals need to provide their personal information, signature, and indicate the specific permissions they are granting to UPMC.
What is the purpose of consent form - upmc?
The purpose of the consent form - upmc is to ensure that UPMC has permission to use and share an individual's personal information in compliance with privacy laws and regulations.
What information must be reported on consent form - upmc?
The consent form - upmc must include details such as the individual's name, contact information, medical history, treatment plans, and any restrictions on the use or sharing of their information.
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