Would you like to join the Health In Our Hands network?
We’d like you to be part of a new patient research network called “Health in Our Hands.” Through this network, you will work with researchers and doctors to give and get information. There is no known health risk to take part in Health in Our Hands. There is no cost for participation.
What Is Health In Our Hands?
Health in Our Hands is a community network that sees the patient community as the expert. It gives you the chance to share what is important to you and your health. The purpose of the network is to connect patients to the research community. A benefit to participating is that we will also send you up-to-date news and resources related to your health, including research opportunities that you may be able to provide input on or participate in. Joining Health in Our Hands is up to you. If you choose not to join, it won’t affect your current health care options.
Regarding employees who participate in the study, there will be no privilege given for participating in this research study. Likewise, there will be no penalty or drawbacks associated with not participating. Participation is strictly voluntary and will not be tied to any preferential treatment or promotion within the company.
What happens when I join Health in Our Hands?
- We will ask for your name and contact information for email or text messages.
- We may ask you to answer surveys about your health and daily life. We will link the answers you give us to your health treatment record. This is meant to give researchers more information about your health. There are no right or wrong answers to the questions. You can skip any question you don’t want to answer.
- We may contact you by phone, text, email, in the future:
- To send you surveys about your health and daily life.
- To tell you about studies that you might be able to join.
- To share information with you, like health tips and research results.
What is the purpose of this authorization form?
Under federal law (the “Privacy Rule”), your Protected Health Information (PHI) cannot be used to conduct research or given to anyone for research purposes without your permission. This form is called an “Authorization” and if you agree to this Authorization, you are giving permission to contact you and conduct research on your health information. You may not join Health in Our Hands unless you approve this authorization.
What is the purpose of this research?
This research will provide information about your health and quality of life for the purpose of informing health care research improvements. The answers you provide to surveys sent to the Health in Our Hands network can be linked to data from your health record and used for research. A number of researchers and organizations work with Health in Our Hands. They may use the information you provide and share it with others for research purposes. We want you to know who may use this information and how they may use it.
Who may use and give out information about you?
When you join the network, your information may be used only by authorized researchers for approved research purposes. Your contact information will never be sold and will only be shared with others if required by law.
Who may see this information?
Authorized researchers that work with Health in Our Hands may see your health information, but they will not know your identity. We will use strict privacy protections to keep your information private and secure. Your information could be subject to disclosure only if required by law.
What information may be used and shared?
If you join the network, we may ask you to answer surveys about research and/or your health. The answers you provide will be linked to data from your health record and used for research. Only authorized researchers will be able to use your medical information to complete studies. Researchers will not know your identity.
Why will this information be used and/or shared?
The information that will be used for Health in Our Hands includes the information that has been collected during the recruitment process and the health information about you in medical records. It may be used to determine what information will be sent to you from Health in Our Hands. Your health information may also be used for research studies. Research results may be published in scientific journals or presented at medical meetings but in these situations, your identity will not be disclosed.
What if I decide not to give permission to use and give out my health information?
By agreeing to this authorization, you are giving Health in Our Hands permission to share your health information for the purposes described above. You may also choose not to join the network.
May I withdraw or revoke (cancel) my permission?
Yes, but this authorization (permission) will not expire (end) unless you cancel it in writing. You may withdraw your permission to use and disclose your health information at any time by contacting Health in Our Hands representatives at firstname.lastname@example.org.
When you withdraw your permission, no new information will be gathered by the network after that date. Information that has already been gathered may still be used.
How long is my information kept?
Your contact information will be kept as long as Health in Our Hands is active unless you cancel this authorization. If you cancel your permission, Health in Our Hands will not contact you anymore. Information that you already provided may still be used.
How do I join?
You may click “I agree” to join the Health in Our Hands patient network. Agreeing to join confirms that you authorize the use of your health information for the patient network and that we may ask you more survey questions after today. You also authorize us to send you health information we think is important to you.
What are the costs involved in participating in research?
There are no known direct costs related to participating in this research. Indirect costs related to your participation include the time needed to take surveys. Finally, if you use the Health in Our Hands online portal, you might experience out-of-pocket expenses related to Wi-Fi, internet or data charges.
Who do I contact with questions?
If you have questions about Health in Our Hands, you can by contact representatives at email@example.com.
If you have questions regarding your rights as a research participant, or if you have questions, concerns, complaints about the research, would like information, or would like to offer input, you may contact the Sterling Institutional Review Board Regulatory Department, 6300 Powers Ferry Road, Suite 600-351, Atlanta, Georgia 30339 (mailing address) at telephone number 1-888-636-1062 (toll free).