An example of a form that a patient would sign to allow a physician/clinic to release their contact information to a research team for eligibility screening and enrollment in a project. Click here to download.
Pace WD, Staton EW, Holcomb S. Practice-based research network studies in the age of HIPAA. Annals of Family Medicine. 2005;3(Suppl 1):S38-S45.  http://www.annfammed.org/cgi/data/3/suppl_1/s38/DC1/2