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CCF IRB #: 13188 Approval Date: 3/7/2016 Expiration Date: 3/6/2017 ClevelandClinic ConsenttoParticipateinaResearchStudy Subtitle:InternationalCollaborativeStudy(ICS)ofSusacsSyndrome PrincipalInvestigator:RobertRennebohm,

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How to fill out cleveland clinic consent to

01

Obtain the Cleveland Clinic consent form.

02

Read the form thoroughly and understand the information provided.

03

Fill in your personal information such as your name, address, date of birth, and contact details.

04

Provide any relevant medical information that is required.

05

Review the consent statements carefully and make sure you agree with the terms and conditions.

06

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07

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08

Keep a copy of the completed consent form for your records.

09

Submit the filled-out consent form to the relevant department or healthcare provider.

Who needs cleveland clinic consent to?

01

Anyone who is receiving medical treatment or services from Cleveland Clinic may need to fill out the Cleveland Clinic consent form. This includes patients, research participants, and individuals involved in clinical trials.

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What is cleveland clinic consent to?

Cleveland Clinic consent form is a document that allows the clinic to use a patient's personal information for treatment, payment, and healthcare operations purposes.

Who is required to file cleveland clinic consent to?

All patients or their legal guardians are required to fill out the Cleveland Clinic consent form.

How to fill out cleveland clinic consent to?

Patients can fill out the Cleveland Clinic consent form by providing their personal information, signing the form, and indicating their consent for the clinic to use their information.

What is the purpose of cleveland clinic consent to?

The purpose of the Cleveland Clinic consent form is to ensure that patients understand and agree to how their personal information will be used by the clinic.

What information must be reported on cleveland clinic consent to?

The Cleveland Clinic consent form typically requires patients to provide their name, contact information, insurance details, and consent for treatment.

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