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1. Parties: Identification of the patient (or legal guardian) and the healthcare provider/institution seeking consent for publication
2. Background: Brief context about the medical case and reason for seeking publication consent
3. Definitions: Clear definitions of key terms like 'Publication', 'Personal Information', 'Medical Information', 'Images', etc.
4. Purpose of Publication: Detailed explanation of why the case is being published and where it will be published
5. Information to be Published: Specific details about what information, images, or data will be included in the publication
6. Extent of Anonymity: Clear statement about how the patient's identity will be protected and what identifying information might be included/excluded
7. Patient Rights: Outline of the patient's rights regarding withdrawal of consent and limitations on use
8. Declaration of Consent: Formal statement of consent with specific permissions granted
9. Execution: Signature section for patient/guardian and healthcare provider representatives
1. Translation Declaration: Required when the patient's primary language is not English, confirming that the contents have been explained in their preferred language
2. Guardian Authorization: Required when the patient is a minor or lacks capacity to provide consent
3. Commercial Usage Rights: Required when there's potential for commercial use of the published material
4. Digital/Social Media Usage: Required when publication might include sharing on digital platforms or social media
5. Future Usage Rights: Optional section specifying rights for future use of the information in other publications or formats
1. Schedule 1 - Details of Publication: Specific details about the publication(s) where the information will appear, including journal names, types of publications, etc.
2. Schedule 2 - Information and Images: Copies or descriptions of exactly which information, photographs, or images will be published
3. Schedule 3 - Privacy Protection Measures: Detailed description of steps taken to protect patient privacy and confidentiality
4. Appendix A - Patient Information Sheet: Detailed information provided to patient about the publication process and implications
5. Appendix B - Withdrawal Form: Template form for withdrawing consent if patient chooses to do so later
Healthcare
Medical Research
Academic Medicine
Medical Publishing
Clinical Education
Pharmaceutical Research
Biotechnology
Medical Device Industry
Public Health
Medical Education
Legal
Medical Affairs
Clinical Research
Compliance
Ethics Committee
Medical Writing
Data Protection
Clinical Operations
Research & Development
Medical Education
Publications
Patient Relations
Medical Records
Quality Assurance
Medical Director
Chief Medical Officer
Research Coordinator
Clinical Trial Manager
Medical Journal Editor
Healthcare Compliance Officer
Medical Ethics Officer
Clinical Research Associate
Medical Writer
Healthcare Legal Counsel
Data Protection Officer
Research Ethics Committee Member
Clinical Department Head
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