SDOH Clinical Care
3.0.0 - STU 3 United States of America flag

This page is part of the SDOH Clinical Care for Multiple Domains (v3.0.0: STU 3) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Example Consent: SDOHCC Consent Information Disclosure Example

Page standards status: Informative

Attachment

An example of a Consent for information disclosure related to SDOH information with a PDF attachment.

Participants

RoleDetails
PatientCOLIN V. ABBAS Male, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))
ManagerOrganization CDE Payer

This consent is made under the regulation HIPAA Authorization .

The subject has given their consent.