The following form authorizes a marketing research organization, or a similar such person or business, to record the picture and/or voice of a person on photographs, films, audio and/or videotapes, and to use same in still photographs, transparencies, motion pictures, television, video or similar such media, in connection with a marketing study.
Authorization To Release Info Form
State:
Multi-State
Control #:
US-01707BG
Format:
Word;
Rich Text
Instant download
Description
Free preview
How to fill out Release And Authorization To Use Photographs And Testimonials In Study?
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FAQ
Elements of a release formPatient information. Naturally, the release should require the patient's information so it's clear who the form refers to.Receiving party's information.Information to be shared.Purpose of the release.Expiration of authorization.Disclaimers.Date and signature.
A: You must write the form in plain language and include the following parts:A description of the information that you will use or disclose and the purpose of it.The name(s) or other identification of the person (or class of persons) authorized to request the use or disclosure of PHI.More items...
The core elements of a valid authorization include:A meaningful description of the information to be disclosed.The name of the individual or the name of the person authorized to make the requested disclosure.The name or other identification of the recipient of the information.More items...
A: You must write the form in plain language and include the following parts:A description of the information that you will use or disclose and the purpose of it.The name(s) or other identification of the person (or class of persons) authorized to request the use or disclosure of PHI.More items...