Joseph H. Kanter Foundation



LHS.networkJonathan Silversteinhttp://lhs.networkJHK FoundationWe are asking you to enroll in the study since you are an adult [ Participating Institution ] patient. If you decide to participate, we will collect, process, and store your extracted electronic health record data, along with data from many other volunteers. We (LHS.network) will carry out research on these samples and data.From time to time we will update the research database with information from your electronic health record, such as demographic information, medical history, test results, medical procedures, images (such as X-rays), medicines you take, and other information in your electronic health record. Some of this clinical information could be considered sensitive, such as various diagnoses, behaviors, and conditions. Your privacy is very important to us, and we will make every effort to protect it. Information you provide will be recorded in the research database at LHS.network. All identifiable computer records will be maintained on an internal network that is not accessible from the Internet. Access to this research database is restricted to study- associated personnel.The research staff involved in this LHS.network research initiative, the [ Local IRB ] that oversees the research, and US agencies that oversee or review research, such as the National Institutes of Health. By agreeing to participate in this study you are authorizing the LHS.network researchers to use your PHI identifiers. Your PHI identifiers will only be used for the purposes described in this Consent Form.This protocol does not have an expiration date. However, you can withdraw at any time.Qualified researchers will be able to apply for accessing health information collected in this study. The LHS.network scientific access committee will review each request for study data, and for any recontacting for future research. You have no obligation to volunteer for future studies. Each future study involving recontact will have its own consent process, which will provide you details to help you decide whether or not to take part. The [ Local IRB ] will also review the applications.Information Privacy: During this research, we will collect identifiable personal health information (PHI) from your electronic health record; specifically, your name, address/es, date-of-birth, phone number/s, fax number/s, email address/es, Social Security number, and medical record number. We refer to this information simply as “PHI identifiers.” The PHI identifiers in the research database are limited in this study to information contained in your electronic health record already. We have established systems to protect your PHI. Except as required by law, or as detailed in this form, we will not release identifiable information. To help ensure confidentiality, we will assign a research number to you and your name will not be used. Some situations legally require mandatory reporting (breaking confidentiality) such as certain communicable diseases or to protect someone from abuse or harm. When the results of the study are published in a medical book or journal or used to teach others, your PHI identifiers will not be shown.If you decide to participate, there will be no guaranteed direct benefit to you. We hope such knowledge will contribute to improvements in prevention, diagnosis, and treatment for various diseases. You may indirectly benefit by feeling that you are helping people in the future.You can find more information about your rights as a volunteer at LHS.network/subjects.There are no costs to you for being in this study.You can withdraw from this study anytime during your life by choosing to withdraw using the LHS.network patient portal or the MyChart patient portal.CA, IL, FLUSA