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Phone (843) 958-1281 Fax: (843) 958-1278 AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION Patient Name Date of Birth Pt Address City State Zip Code SS # The undersigned hereby authorizes
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PMG Research of Charleston is a clinical research site located in Charleston, South Carolina that conducts research studies on various medical conditions.
Patients who are participating in a research study at PMG Research of Charleston may be required to file certain paperwork related to their participation.
To fill out PMG Research of Charleston paperwork, participants typically need to provide personal information, medical history, and consent forms.
The purpose of PMG Research of Charleston is to conduct clinical research studies to advance medical knowledge and improve patient care.
Information such as personal details, medical history, study consent, and any adverse events must be reported on PMG Research of Charleston paperwork.
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