Medical Records Release

Update on COVID-19

To: Our Sponsors, CROs, Patients, and Employees

At CenExel Clinical Research, our top priorities are the safety and health of our patients and employees. For our Centers of Excellence to provide the highest quality of clinical research, we established and maintain a COVID-19 Task Force with representatives from every Center. The Task Force is charged with continuous monitoring of the pandemic and providing guidance and communication.

Our clinical operations continue, and we have implemented the following additional safety measures:

Enhanced screening of everyone entering any of our facilities before they are admitted into our offices or clinical areas
Reinforced internal communication regarding the COVID-19 situation, CDC and SHRM recommendations, digital team meetings, and the importance of using sick leave for anyone who has signs, symptoms, or recent exposure to someone with suspected or diagnosed COVID-19
Additional cleaning and disinfecting materials provided through our clinic and office areas
Cross-training and preparations for contingency plans if key staff need to stay home

We will continue to monitor the current situation, coordinate with the proper authorities, and update our policies and procedures as needed to ensure the safety of our patients and employees.

AUTHORIZATION FOR MEDICAL RECORDS RELEASE

Participant Name

Date of Birth

Phone Number

Information Requested

Authorization:*

I acknowledge, and hereby consent to such, that the released information may contain information relating to:

Purpose of Disclosure:*

Physician Contact Information

Name of Physician

Consent*

Signature*

Name Of Signer*

Relationship to Participant*

When would you like this release to expire?

Today's Date*

CenExel RMCR Site Privacy Policy and Terms of Use

Agreement*

Update on COVID-19

To: Our Sponsors, CROs, Patients, and Employees

AUTHORIZATION FOR MEDICAL RECORDS RELEASE

Participant Name

Date of Birth

Phone Number

Information Requested

Authorization:*

I acknowledge, and hereby consent to such, that the released information may contain information relating to:

Purpose of Disclosure:*

Physician Contact Information

Name of Physician

Consent*

Signature*

Name Of Signer*

Relationship to Participant*

When would you like this release to expire?

Today's Date*

CenExel RMCR Site Privacy Policy and Terms of Use

Agreement*

​Update on COVID-19

To: Our Sponsors, CROs, Patients, and Employees

Update on COVID-19