№ lp_2_3_22622
Informed consent and authorization document outlining conditions for collecting and disclosing medical information about a pregnancy and infant health when the biological father participates in a clinical research study involving an investigational drug.
Institution: The University of Toledo
Document Type: Informed Consent Form and HIPAA Authorization
Study Context: Pregnancy occurring while male partner participates in a research study
Principal Investigator: Not specified
Sponsor: Not specified
Regulatory Authorities Referenced: U.S. Food and Drug Administration (FDA); Department of Health and Human Services (DHHS)
Ethical Oversight: The University of Toledo Institutional Review Boards
Purpose: Collection of medical information regarding pregnancy, outcome, and infant health
Data Subjects: Pregnant partner and newborn child
Compensation: None for participant
Costs: No cost for data collection; routine medical care billed as usual
Confidentiality Scope: Use and disclosure of protected health information
Authorization Expiration: When the child reaches age 18 unless revoked earlier
Geographic Scope: United States with possible international data transfer
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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