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Patient Consent For Publication
"I need a Patient Consent For Publication form for a case study involving medical imaging of a rare neurological condition, which will be published in an international medical journal, with special attention to data protection requirements for sharing across multiple research institutions."
1. Patient Information: Patient's personal details and medical record number
2. Publication Details: Specific information about where and how the medical information will be published
3. Scope of Consent: Detailed description of what information will be published and how it will be used
4. Privacy Protection Measures: Description of anonymization and data protection procedures
5. Rights and Withdrawal: Patient's rights including the right to withdraw consent
1. Image Usage Authorization: Additional section required when photographs or medical imaging will be published
2. Third Party Access: Details about other parties who may access the information, used when data will be shared with multiple institutions or researchers
3. Commercial Usage: Provisions for commercial use of the information, included when publication may have commercial applications
1. Schedule A - Details of Publication: Specific details about the intended publication, including journal name, article type
2. Schedule B - Materials for Publication: List of specific materials (images, data, case details) to be published
3. Appendix 1 - Privacy Protection Protocols: Detailed procedures for ensuring patient privacy and data protection
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