PATIENT CONSENT FORM


Patient Consent Form
The journal requires at the point of submission that a consent form has been completed for any case report or clinical image in which an individual or a group of individuals can be identified. The list below outlines potential patient identifiers to be aware of.

  • Direct
  • Name
  • Initials
  • Address, including full or partial postal code
  • Telephone or fax numbers or contact information
  • Electronic mail addresses
  • Unique identifying numbers
  • Vehicle identifiers
  • Medical device identifiers
  • Web or internet protocol addresses
  • Biometric data
  • Facial photograph or comparable image
  • Audiotapes
  • Names of relatives
  • Dates related to an individual (including date of birth)
  • Indirect–may present a risk if present in combination with others in the list
  • Place of treatment or health professional responsible for care (Could be inferred from investigator affiliations)
  • Sex
  • Rare disease or treatment
  • Sensitive data, such as illicit drug use or “risky behaviour”
  • Place of birth
  • Socioeconomic data, such as occupation or place of work, income, or education (MRC requirement is for “rare” occupations only)
  • Household and family composition
  • Anthropometry measures
  • Multiple pregnancies
  • Ethnicity
  • Small denominators–population size of <100
  • Very small numerators–event counts of <3
  • Year of birth or age (Age is potentially identifying if the recruitment period is short and is fully described)
  • Verbatim responses or transcripts
More guidance can be found here: https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-11-9