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Please note the following when using the Affidavit of Consent to Publish:

  1. Pages 1 and 2 are for patients of legal age and literate in reading and writing.
  2. Pages 3 and 4 are for the legal representatives of patients not of legal age, patients of legal age but illiterate in reading and writing, and/or incapable of signing the document (e.g. patients who are expired, unconscious or with disabilities).
  3. Reproduce the form into four (4) copies before obtaining the signatures so that all signatures are original, and secure a photocopy of the signatory's valid ID with three (3) specimens.
  4. Explain to the subject that this consent states that he/she will not have full anonymity and there will be a possibility that someone may recognize him/her especially when his/her medical experience is rare or unique.