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1. Patient Information: Patient's personal details including name, date of birth, hospital/reference number, and contact information
2. Healthcare Provider Information: Details of the primary healthcare provider, institution, and department responsible for the case report
3. Purpose of the Case Report: Clear explanation of why the case report is being written and its intended use in medical literature
4. Information to be Published: Specific details about what medical information will be included in the case report
5. Confidentiality Statement: Explanation of how the patient's privacy will be protected and what identifying information will be removed or anonymized
6. Patient Rights: Clear statement of the patient's rights, including the right to withdraw consent
7. Voluntary Nature of Consent: Statement confirming that participation is voluntary and refusal won't affect medical care
8. Declaration and Signatures: Formal declaration of consent and signature blocks for patient, healthcare provider, and witness
1. Translator Confirmation: Required when the patient's primary language is not the language of the consent form, including translator's details and confirmation
2. Legal Representative Authorization: Required when the patient is unable to provide consent themselves or is a minor
3. Image/Photography Consent: Required when photographs, x-rays, or other medical images will be included in the case report
4. Financial Disclosure: Required when there are any financial implications or when the case report is funded by specific entities
5. Future Use Permission: Optional section for consent to use the case report in future research or publications
1. Description of Medical Case: Detailed but lay-friendly description of the medical case being reported
2. List of Information to be Published: Itemized list of specific medical information, test results, or images to be included in the report
3. Privacy Protection Measures: Detailed description of steps taken to protect patient privacy and anonymize data
4. Patient Rights Summary: Simple language summary of patient rights and protection measures in bullet point format
Healthcare
Medical Research
Academic Medicine
Clinical Practice
Hospital Administration
Medical Education
Pharmaceutical Research
Biotechnology
Public Health
Medical Publishing
Legal
Compliance
Research Ethics
Clinical Research
Medical Records
Patient Administration
Quality Assurance
Medical Writing
Clinical Documentation
Privacy and Data Protection
Medical Education
Publication
Medical Doctor
Clinical Researcher
Research Ethics Officer
Legal Compliance Officer
Medical Writer
Healthcare Administrator
Clinical Trial Coordinator
Medical Journal Editor
Research Director
Privacy Officer
Medical Records Manager
Hospital Administrator
Research Nurse
Medical Education Coordinator
Clinical Documentation Specialist
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