The Patient Consent Form For Case Report is a critical document used in New Zealand healthcare settings when medical practitioners wish to publish individual patient cases in medical literature or academic journals. This document serves as a formal agreement between the healthcare provider and the patient, ensuring informed consent is obtained in compliance with the Health Information Privacy Code 2020 and the Code of Health and Disability Services Consumers' Rights 1996. The form must be completed before any patient information can be used in a published case report, and it includes specific details about what information will be published, how patient privacy will be protected, and the rights of the patient regarding their information. It represents a crucial step in contributing to medical knowledge while protecting patient privacy and maintaining ethical standards in medical research and publication.
Your data doesn't train Genie's AI
You keep IP ownership of your information
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
OR
Let Genie AI's market-leading legal AI identify missing terms, unusual language, compliance issues and more - in just seconds.
Upload your Doc
1. Title and Document Identification: Clear identification of the document as a Patient Consent Form for Case Report, including institution name and form version/date
2. Patient Information: Patient's name, date of birth, contact details, and medical record number (while noting that this may be anonymized in the actual case report)
3. Healthcare Provider Information: Name and contact details of the primary healthcare provider/researcher responsible for the case report
4. Purpose of the Case Report: Clear explanation of why the case report is being written and its intended use in medical literature
5. Information to be Published: Specific details about what medical information will be included in the case report
6. Confidentiality Statement: Explanation of how patient's privacy will be protected and what identifying information will be removed/modified
7. Rights Statement: Clear outline of patient's rights, including the right to withdraw consent
8. Consent Declaration: Formal statement of consent with specific permissions being granted
9. Signatures: Space for patient (or legal representative) signature, date, and witness signature if required
1. Interpreter Declaration: Required when the patient's primary language is not English or when an interpreter is used
2. Legal Representative Authorization: Required when the patient is unable to provide consent themselves
3. Photography/Images Consent: Required when the case report will include photos, x-rays, or other images of the patient
4. Future Use Permission: Optional section for consent to use the case report in future medical education or research
5. Financial Disclosure: Required when there are any financial implications or compensation related to the case report
6. Publication Details: Optional section specifying intended publication venues or specific journals
1. Description of Case Report: Detailed outline of the medical condition or procedure that will be described in the case report
2. Image Schedule: List and descriptions of any images or medical records that will be included in the publication
3. Privacy Protection Measures: Detailed description of steps taken to protect patient privacy and confidentiality
4. Patient Rights Information Sheet: Detailed information about patient rights under New Zealand law regarding medical information and privacy
5. Withdrawal Process Guide: Detailed information about how to withdraw consent and the implications of withdrawal
Relevant legal definitions
Case Report
Personal Information
Health Information
Consent
Publication
Healthcare Provider
Medical Journal
Anonymisation
Confidential Information
Clinical Images
Medical Records
Withdrawal of Consent
Legal Representative
Principal Investigator
Research Institution
Protected Health Information
Identifying Information
Academic Use
Educational Purpose
Medical Literature
Privacy Protection Measures
Professional Audience
Data Protection
Publication Rights
Authorized Recipients
Personal Information
Health Information
Consent
Publication
Healthcare Provider
Medical Journal
Anonymisation
Confidential Information
Clinical Images
Medical Records
Withdrawal of Consent
Legal Representative
Principal Investigator
Research Institution
Protected Health Information
Identifying Information
Academic Use
Educational Purpose
Medical Literature
Privacy Protection Measures
Professional Audience
Data Protection
Publication Rights
Authorized Recipients
Clauses
Consent
Privacy
Confidentiality
Data Protection
Publication Rights
Patient Rights
Withdrawal Rights
Information Use
Image Rights
Medical Records Access
Third Party Disclosure
Anonymity Protection
Duration and Survival
Liability and Indemnification
Governing Law
Dispute Resolution
Amendment and Modification
Severability
Entire Agreement
Acknowledgment and Declaration
Privacy
Confidentiality
Data Protection
Publication Rights
Patient Rights
Withdrawal Rights
Information Use
Image Rights
Medical Records Access
Third Party Disclosure
Anonymity Protection
Duration and Survival
Liability and Indemnification
Governing Law
Dispute Resolution
Amendment and Modification
Severability
Entire Agreement
Acknowledgment and Declaration
Relevant Industries
Healthcare
Medical Research
Academic Medicine
Clinical Practice
Medical Education
Medical Publishing
Healthcare Administration
Medical Ethics
Relevant Teams
Legal
Compliance
Medical Records
Research
Clinical Operations
Ethics Committee
Privacy Office
Medical Affairs
Publication
Patient Services
Quality Assurance
Relevant Roles
Medical Doctor
Clinical Researcher
Research Nurse
Medical Ethics Officer
Privacy Officer
Healthcare Administrator
Clinical Director
Medical Writer
Research Coordinator
Legal Counsel
Compliance Officer
Medical Records Manager
Research Ethics Committee Member
Medical Publisher
Academic Medical Professor
Find the exact document you need
Temporary Guardianship Agreement Form
A New Zealand legal document establishing temporary guardianship arrangements for children under the Care of Children Act 2004.
find out more
Photo Consent Form For Social (Media)
A New Zealand-compliant consent form for obtaining permission to use photographs on social media platforms, aligned with local privacy laws.
find out more
Photo And Video Consent Form
A New Zealand-compliant consent form for the capture and use of photographs and video footage of individuals, adhering to local privacy laws and usage rights requirements.
find out more
Parental Advice For Marriage Form
A New Zealand legal form documenting parental consent and advice for the marriage of a minor (aged 16-17), as required under the Marriage Act 1955.
find out more
Parent Consent Form For Student Permit
A New Zealand legal document providing parental consent for a minor's student permit application and study arrangements, complying with NZ immigration and education laws.
find out more
Owners Consent Form
A New Zealand legal document providing formal authorization from a property owner for specific activities or changes related to their property, required for various regulatory applications.
find out more
Facial Consent Form
A New Zealand-compliant consent form for facial treatments that captures client information, medical history, and informed consent while meeting local regulatory requirements.
find out more
Electronic Signature Consent Form
A New Zealand-compliant consent form authorizing the use of electronic signatures in business transactions under the Electronic Transactions Act 2002.
find out more
Consent Permission Letter
A formal document used in New Zealand to obtain and record explicit permission from individuals or authorized representatives, compliant with NZ Privacy Act 2020.
find out more
Affidavit Support And Consent Parental Travel Permit
A New Zealand legal document providing parental authorization and support for a minor's travel, compliant with NZ family law and immigration requirements.
find out more
Permission Letter To Principal From Parents
A New Zealand-compliant formal letter from parents to school principal granting specific authorization for student participation in school activities.
find out more
Employee Driving Licence Check Consent Form
A New Zealand-compliant consent form for employers to check and monitor employee driving licences, meeting Privacy Act and Land Transport Act requirements.
find out more
Privacy Consent Form
A New Zealand-compliant legal document for obtaining consent to collect, use, and disclose personal information under the Privacy Act 2020.
find out more
Consent For Dental Treatment
A New Zealand-compliant dental treatment consent form documenting informed consent between dental practitioners and patients for proposed dental procedures.
find out more
Permission Form
A New Zealand-compliant permission form template for obtaining formal consent for activities, events, or data usage, adhering to local privacy and contract laws.
find out more
Parent Consent Form For Travel
A New Zealand-compliant legal document providing parental authorization for a minor's travel, meeting requirements under NZ law for domestic and international journey consent.
find out more
Landlord Consent Letter
A formal New Zealand legal document where a landlord grants specific permission to a tenant, typically for subletting or lease assignment, in compliance with NZ property law.
find out more
Standard Media Release Form
A New Zealand-compliant legal document granting permission for the use and distribution of an individual's image, voice, or likeness in media content.
find out more
Permission Letter From Parents
A New Zealand-compliant formal document providing parental authorization for child-related activities or services, governed by NZ law including the Care of Children Act 2004.
find out more
Medical Release For Grandparents
A New Zealand-compliant legal document authorizing grandparents to make medical decisions for their grandchildren in the parents' absence.
find out more
Veterinary Consent Form
A New Zealand-compliant legal document for obtaining informed consent from pet owners for veterinary procedures and treatments.
find out more
Trip Consent Form
A New Zealand-compliant consent form for obtaining parental/guardian permission for organized trips, including medical information and emergency contacts.
find out more
Permission Consent Form
A New Zealand-compliant legal document used to obtain and document explicit authorization from individuals for specific activities or permissions.
find out more
Personal Data Consent Form
A New Zealand-compliant Personal Data Consent Form for collecting and processing personal information under the Privacy Act 2020.
find out more
Consent Form For Research Questionnaire
A New Zealand-compliant consent form for research questionnaire participation, covering participant rights, data privacy, and research procedures under NZ law.
find out more
Consent For Emergency Medical Treatment
A New Zealand-compliant legal document authorizing healthcare providers to administer emergency medical treatment when immediate consent cannot be obtained.
find out more
Waxing Consent Form
A New Zealand-compliant consent form for waxing services that documents client approval and understanding of treatment risks while protecting service provider liability.
find out more
Unaccompanied Minor Travel Consent Form
A New Zealand-compliant legal form authorizing unaccompanied minor travel, including parental consent and travel arrangements under NZ law.
find out more
Sports Consent Form
A New Zealand-compliant consent form for sports participation that covers personal information, medical details, and risk acknowledgment under NZ law.
find out more
Patient Consent For Publication
A New Zealand-compliant consent form for publishing patient medical information in academic/medical literature, aligned with NZ privacy and healthcare laws.
find out more
Passport Affidavit For Minor
A sworn legal document required in New Zealand for obtaining a minor's passport, particularly in cases requiring special declarations or single parent consent.
find out more
Neighbours Consent Form
A New Zealand legal document obtaining formal consent from neighboring property owners for works or modifications that may affect their property.
find out more
Letter Of Consent To Use Property For Business
A New Zealand-compliant legal document granting permission to use a property for specified business activities, outlining terms and conditions of commercial use.
find out more
Disclosure Consent Form
A New Zealand-compliant consent form for authorizing the collection, use, and disclosure of personal information under NZ Privacy Act 2020.
find out more
Data Privacy Consent Form
A New Zealand-compliant consent form for collecting and processing personal information under the Privacy Act 2020.
find out more
Consent To Disclosure Of Information
A New Zealand law-compliant document authorizing the disclosure of specified information between parties, governed by the Privacy Act 2020.
find out more
Consent Letter For Background Check
A New Zealand-compliant consent letter authorizing employers to conduct pre-employment background checks while adhering to local privacy and employment laws.
find out more
Consent Form For Field Trip
A New Zealand-compliant consent form for school field trips, ensuring legal authorization for student participation in educational excursions.
find out more
Consent For An Access To Information And Personal Information Request
A New Zealand-compliant consent form for authorized access to and handling of personal information, aligned with the Privacy Act 2020.
find out more
Authorization Letter From Parent For Guardian
A New Zealand legal document that enables parents to temporarily delegate guardianship responsibilities to another person under the Care of Children Act 2004.
find out more
Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it
.png)
.png)