Research Consent and Authorization Helix Research Network( HRN)
OR REVIEW ONLY
IRB APPROVED May 19, 2025
● Better understand the diseases being studied and to improve the design of future studies
● To evaluate the results of the study
Who will your PHI be shared with?
● Renown Health and its affiliated clinicians, providers and entities participating in the research
● Helix, the study sponsor, including any entity or contractor engaged by Helix to support the research
● Any sponsor of a sub-study that you agree to participate in and any entity or contractor engaged by such sponsor to support the substudy
● Helix’ s interpretation partners and other entities or contractors engaged by Helix to support the clinical return of genetic results
● Members of the Helix Research Network
● Individuals and entities with access to publicly accessible research databases into which the study data are placed
● Federal and state agencies or other domestic government bodies if required by law and / or necessary for oversight purposes. A representative from the FDA may review your medical records.
● Hospital accrediting agencies
● The Institutional Review Board
Those persons who receive your health information may not be required by Federal privacy laws( such as the Privacy Rule) to protect it and may share your information with others without your permission, if permitted by laws governing them.
What if I decide not to allow the use of my PHI? You do not have to sign this form. If you do not sign this form, you cannot take part in this research study. Choosing not to give this Authorization or canceling your authorization will have no effect on your regular health care treatment, payment, or benefits.
May I withdraw or revoke( cancel) my permission? Yes. You may withdraw your permission to use and disclose your PHI at any time for any reason. You can do this by sending written notice to the
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