[if Methodist research procedures are taking place at both Methodist and Le Bonheur, add] Le Bonheur Healthcare [if Le Bonheur research procedures are taking place at Le Bonheur add] Children’s Hospital Children’s Hospital [if Methodist research procedures are taking place at Methodist Hospitals, add] Hospitals [if Regional One Health research procedures are taking place at Regional One Health, add] [if University research procedures are taking place at University Clinical Health, add] Clinical Health [if research procedures are taking place at a UT Le Bonheur Pediatric Specialists facility, UT Le Bonheur Pediatric Specialists, Inc. add] [if [name which sponsors and provides funds for your study has a sponsor, add] of sponsor], this research [if [name which has been hired by the sponsor to coordinate the applicable, add] of CRO], study [if A Data and Safety Monitoring Board (DSMB) applicable, add] [If you included a sponsor, CRO, DSMB, or similar unaffiliated organization in the above bullet However, some of these organizations or institutions above do not have point list, you must add:] the same obligations to protect your PHI. Your PHI will only be used and/or given to others: To do the research To study the results To see if the research was done correctly [Provide an expiration date for the authorization by choosing one of the following 3 statements:] Your PHI will be used until the study is completed. [OR] [if Your PHI will be used for as long as the sponsor reports the research is FDA-regulated, state] study information to the FDA. [OR] [if Your the research is without a foreseeable end point, such as a repository or a registry, state] PHI will be used indefinitely.
[if research procedures are taking place at both Methodist and Le Bonheur, add] Methodist Le Bonheur Healthcare [if research procedures are taking place at Le Bonheur Children’s Hospital add] Le Bonheur Children’s Hospital [if research procedures are taking place at Methodist Hospitals, add] Methodist Hospitals [if research procedures are taking place at Regional One Health, add] Regional One Health [if research procedures are taking place at University Clinical Health, add] University Clinical Health [if research procedures are taking place at a UT Le Bonheur Pediatric Specialists facility, add] UT Le Bonheur Pediatric Specialists, Inc. [if your study has a sponsor, add] [name of sponsor], which sponsors and provides funds for this research [if applicable, add] [name of CRO], which has been hired by the sponsor to coordinate the study [if applicable, add] A Data and Safety Monitoring Board (DSMB) [If you included a sponsor, CRO, DSMB, or similar unaffiliated organization in the above bullet point list, you must add:] However, some of these organizations or institutions above do not have the same obligations to protect your PHI. Your PHI will only be used and/or given to others: To do the research To study the results To see if the research was done correctly [Provide an expiration date for the authorization by choosing one of the following 3 statements:] Your PHI will be used until the study is completed. [OR] [if the research is FDA-regulated, state] Your PHI will be used for as long as the sponsor reports study information to the FDA. [OR] [if the research is without a foreseeable end point, such as a repository or a registry, state] Your PHI will be used indefinitely.