Authorization to Use and Disclose Health Information. Institution and Principal Investigator shall provide an appropriate privacy notice to each Trial Subject and obtain a written privacy authorization from each Trial Subject, complying with Applicable Law, which will enable Institution and Principal Investigator to provide Sponsor and other persons and entities designated by Sponsor access to completed case report forms (“CRFs”), source documents and all other information required by the Protocol. If such an authorization is separate from the ICF, Institution and Principal Investigator will only use the authorization that is approved by Sponsor, IEC and/or RA (if applicable).
Authorization to Use and Disclose Health Information. Institution will obtain a written privacy authorization, complying with Applicable Law, for each Trial Subject which will enable 9.1 Oprávnění k použití a odhalení zdravotních údajů Instituce získá písemné oprávnění pro zpracování osobních údajů v souladu s platným zákonem pro každý subjekt klinického hodnocení, Institution to provide Sponsor and entities designated by Sponsor with completed Case Report Forms (“CRFs”), source documents and all other information required by the Protocol. Sponsor or INC Research, though not a covered entity, recognizes that, pursuant to this Agreement, it has the responsibility to protect all individually identifiable Trial Subject information and to restrict the use of such information to those persons and entities, including consultants, contractors, subcontractors and agents, who must have access to such information in order to fulfill their assigned duties with respect to the Trial. Such use also will be restricted to those permitted in the authorization forms and neither Sponsor or INC Research nor any party to whom Sponsor or INC Research may disclose individually identifiable health information may use such information to recruit Trial subjects to additional studies, to advertise additional studies or products, or to perform marketing or marketing research. které instituci umožní poskytovat zadavateli a osobám určeným zadavatelem vyplněné záznamy subjektů klinického hodnocení (Case Report Form neboli CRF), zdrojové dokumenty a všechny další informace vyžadované protokolem. Zadavatel nebo společnost INC Research, i když není krytou osobou, si uvědomuje, že na základě této smlouvy nese odpovědnost za ochranu údajů všech jednotlivě identifikovatelných subjektů klinického hodnocení a za omezení použití těchto informací na jedince a osoby, včetně konzultantů, smluvních stran, dílčích smluvních stran a zástupců, kteří musí mít přístup k těmto informacím kvůli splnění jim přidělených povinností v souvislosti s tímto klinickým hodnocením. Toto použití bude také omezeno na způsoby použití povolené v autorizačních formulářích. Zadavatel, společnost INC Research ani jakákoli strana, které zadavatel nebo společnost INC Research může odhalit jednotlivě identifikovatelné zdravotní údaje, nesmí tyto informace používat pro nábor subjektů klinického hodnocení do dalších studií, pro propagaci dalších studií nebo produktů nebo pro marketing a marketingový výzkum.
Authorization to Use and Disclose Health Information. Institution and Principal Investigator will obtain a written privacy authorization, complying with Applicable Laws and Regulations, for each Trial Subject which will enable Institution and Principal Investigator to provide Sponsor and other persons and entities designated by Sponsor access to completed case report forms (“CRFs”), source documents and all other information required by the Protocol. Sponsor is responsible for the wording of the form. Sponsor, recognizes that, pursuant to this Agreement, it has the responsibility to protect all individually identifiable patient information and to restrict the use of such information to those persons and entities, including consultants, contractors, subcontractors and agents, who must have access to such information in order to fulfill their assigned duties with respect to the Trial. Such use also will be restricted to those permitted in the authorization forms and neither Sponsor nor any party to whom Sponsor may disclose individually identifiable health information may use such information to recruit research subjects to additional studies, to advertise additional studies or products, or to perform marketing or marketing research. Institution and Principal Investigator will only use such authorization that is approved by Sponsor. Sponsor undertakes to provide to Principal Investigator with a sample of Informed Consent that includes all the above requirements.
Authorization to Use and Disclose Health Information. Institution shall provide an appropriate privacy statement to each Trial, complying with Applicable Law, which will enable Institution and Principal Investigator to provide Sponsor and other persons and entities designated by Sponsor access to completed case report forms (“CRFs”), source documents and all other information required by the Protocol. If such an authorization is separate from the ICF, Institution will only use the authorization that is approved by Sponsor, IEC and/or RA (if applicable).
Authorization to Use and Disclose Health Information. Principal Investigator shall provide an appropriate privacy notice to each Trial Subject and obtain a written privacy authorization from each Trial Subject, complying with Applicable Law, which will enable Institution and Principal Investigator to provide Sponsor and other persons and entities designated by Sponsor access to completed CRFs, source documents from specific Trial subjects and all other information required by the Protocol. If such an authorization is separate from the ICF, Principal Investigator will only use the authorization that is prepared by Sponsor, IEC and/or RA (if applicable). 10.1. Souhlas používat a sdělovat zdravotní informaceHlavní zkoušející každý subjekt hodnocení vhodným způsobem upozorní na ochranu osobních údajů a získá od něj písemný souhlas v souladu s platnými zákony písemný souhlas k poskytnutí osobních údajů, který umožní hlavnímu zkoušejícímu, zadavateli a dalším osobám a subjektům určeným zadavatelem přístup k vyplněným formulářům záznamů subjektu („CRF”), zdrojovým dokumentům konkrétních subjektů a všem dalším informacím požadovaných dle protokolu. Není-li tento souhlas uzavřen jako součást formuláře informovaného souhlasu, hlavní zkoušející použije pouze souhlas, který je vypracován zadavatelem, NEK, a/nebo kontrolním úřadem.
Authorization to Use and Disclose Health Information. Sponsor and CRO will prepare an informed consent form. Upon approval from the relevant IEC of such form, Institution will obtain a written privacy authorization, complying with Applicable Law, for each Trial Subject which will enable Institution to provide Sponsor and other persons and entities designated by Sponsor access to completed case report forms (“CRFs”), source documents and all other information required by the Protocol. Sponsor or CRO, though not a covered entity, recognizes that, pursuant to this Agreement, it has the responsibility to protect all individually identifiable patient information and to restrict the use of such information to those persons and entities, including consultants, contractors, subcontractors and agents, who must have access to such information in order to fulfill their assigned duties with respect to the Trial. Such use also will be restricted to those permitted in the authorization forms and neither Sponsor or CRO nor any party to whom Sponsor or CRO may disclose individually identifiable health information may use such information to recruit research subjects to additional studies, to advertise additional studies or products, or to perform marketing or marketing research. If such an authorization is separate from the informed consent form (“ICF”), Institution will only use such authorization that is approved by Sponsor, IEC (if applicable) and regulatory authority (if applicable).
8.1. Souhlas používat a sdělovat zdravotní informace Zadavatel a CRO připraví formulář informovaného souhlasu. Po schválení tohoto formuláře příslušnou NEK, získá zdravotnické zařízení od každého subjektu klinického hodnocení v souladu s platnými zákony písemný souhlas k poskytnutí osobních údajů, který umožní zdravotnickému zařízení zadavateli a dalším osobám a subjektům určeným zadavatelem přístup k vyplněným formulářům záznamů subjektu (case report forms, CRF), zdrojovým dokumentům a všem dalším informacím požadovaným dle protokolu. Zadavatel nebo CRO, ačkoliv se nejedná o smluvní stranu, berou na vědomí, že tato smlouva zakládá povinnost chránit všechny individuálně identifikovatelné údaje o pacientech a omezit jejich používání pouze na osoby a subjekty, včetně konzultantů, dodavatelů, subdodavatelů a zástupců, které potřebují přístup k těmto informacím pro plnění povinností v souvislosti s klinickým hodnocením. Používání těchto údajů bude omezeno na rozsah povolený souhlasem, a zadavatel, CRO, ani žádná jiná strana, které zadavatel a CR...
Authorization to Use and Disclose Health Information. I hereby authorize and direct Audiology Experts to release confidential medical information to any entity, government agency, or insurance carrier in order to secure payment related to services rendered. Audiology Experts may also disclose my health information to the referring physician, family doctor, and school personnel for transfer of medical care, and follow-up purposes.
Authorization to Use and Disclose Health Information. 6.1. Strany uznávají společný cíl zabezpečit všechny osobní údaje a uchovávat tyto informace v důvěrnosti a chránit je před neoprávněným zveřejněním. Strany prohlašují a zaručují, že budou dodržovat ustanovení platných právních předpisů týkajících se důvěrnosti, ochrany soukromí a bezpečnosti těchto osobních údajů. Poskytovatel a Zkoušející navíc dodržují níže uvedená ustanovení.
6.2. Oprávnění k používání a zveřejňování zdravotních informací.
Authorization to Use and Disclose Health Information. Each Party will comply with Applicable Law pertaining to data privacy to the extent such Applicable Law governs its responsibilities and activities under this Agreement. Sponsor, CRO, Institution and Investigator recognize that, pursuant to this Agreement, they have the responsibility to protect all individually identifiable patient information and to restrict the use of such information to those persons and entities, including consultants, contractors, subcontractors and agents, who must have access to such information in order to fulfill their assigned duties with respect to the Trial and in accordance with Applicable Law. Neither Sponsor, CRO, Institution nor Investigator may use such information to recruit Trial Subjects to additional studies, to advertise additional studies or products, or to perform marketing or marketing research.
Authorization to Use and Disclose Health Information. I authorize Xxxxxxxx Xxxxxx, MD, PA to use and disclose all health and medical information relevant to my diagnosis and treatment to the following: For the purpose of diagnosis and treatment of my medical condition. I also Authorize Xxxxxxxx Xxxxxx, MD, PA and his representatives to leave messages including laboratory results on my voicemail/ answering machine even if confidential information might be overheard by others than myself. Home Yes Work Yes Cell Yes No No No You have the right to revoke this authorization any time, provided that you do so in writing and accept the extent that we have already used or disclosed the information in reliance on this authorization. I have reviewed and I understand this Authorization. I also understand that the information used or disclosed pursuant to the Authorization may be subject to redisclosure and no longer protected under federal law. By: Patient Or By: Patient’s Representative Date: Date: Description of representatives Authority: I, , authorize Xxxxxxxx Xxxxxx MD PA to furnish the above Patient information as is requested to the above Health Care Provider. Signature Date Xxxxxxxx Xxxxxx, MD, PA PRIVACY PRACTICES ACKNOWLEDGEMENT I have received a copy of Xxxxxxxx Xxxxxx, MD PA Notice of Privacy Practices and I have been provided the opportunity to review it. Patient Name: Birth Date: SS# Address: Signature: Date: I understand and agree to all of the following:
