Personal Health Information

In cases where a MiTy Kids participant declines full consent we request that you ask the participant to consider signing the Authorization For The Release of Personal Health Information Form (PHI). This from can be sent to their family physician allowing us to collect partial information such as weight and height.

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Once the participant agrees to sign the PHI, please remember to complete the Child Status Form in OpenClinica as soon as possible. This will ensure that the participant has been tracked and accounted for within our system.

The data obtained from the physician can then be added to the Personal Health Information Form in OpenClinica.  Please note that the Authorization For The Release of Personal Health Information Form requests measurements at 2 and 4 months old, when most clinic visits occur; however, the PHI Form in OpenClinica requests the 3 month old measurements. If measurements are obtained for either 2 months only or for 4 months only, please enter the available information. However, if measurements are obtained for both 2 and 4 months, please enter the measurements that are closest to the 3 month old date.  

PHI

Personal Health Information Form

 

Child Status Form

Child Status Form

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