SAMC Patient Authorization Form

Patient authorization is generally not required for case studies, as they typically use de-identified health information. However, some medical journals now require some form of authorization from the patient. This authorization may be necessary when the journal mandates that the author obtain the patient's permission to use their information in the case study.

It is important to note that this authorization cannot be used if the diagnosis is such that it could reasonably identify the patient, such as in the case of a rare disease. Depending on the publisher's requirements, authorization may be obtained either by having the patient sign this document or through verbal consent.

For questions, please contact Phillip Kim, MD, MPH (SAMC GME Research Co-Chair).