Everything in one place

4a. Use of GenSec for your clinical care — please select one:
☐ I authorize my physician practice to use GenSec to support my clinical care, including (if I elect it below) the use of my genetic test results.
☐ I do not authorize use of GenSec for my clinical care at this time.

4b. Genetic testing — please select one:
☐ I authorize genetic testing as described above.
☐ I do not authorize genetic testing at this time. I understand I may change my mind in the future.

10. Your Part B election
Clinical data (medical history, labs, imaging, treatments, outcomes):
☐ I authorize GenSec to include my de-identified clinical data in research datasets that may be shared with the partners listed in Section 7, including paid partnerships, as described in Sections 5–9.
☐ I do not authorize this use of my clinical data.

10. Your Part B election
Genetic data (if you have elected genetic testing in Part A):
☐ I authorize GenSec to include my de-identified genetic data in research datasets as described in Sections 5–9.
☐ I do not authorize this use of my genetic data.

Being told about new findings relevant to your own health (optional)
Genomic science keeps advancing. Because GenSec holds your genome alongside your clinical record, information already collected can sometimes be re-examined as scientific understanding improves. If something emerges that may be relevant to your own health, GenSec or your physician practice may contact you or your practice so it can be reviewed with you.

To make this possible, GenSec needs to keep your information linked to you rather than only in de-identified form. If you decline this option, GenSec will not retain your information in identifiable form for this purpose beyond what your clinical care requires.

Important limits. GenSec may contact you but is under no obligation to do so. GenSec does not undertake to review, re-analyse, reinterpret, or monitor your information on any schedule, and you should not rely on GenSec to do so. Any new information would be reviewed with your physician, who remains responsible for your clinical care. Declining this option does not affect your care.

☐ I agree to be contacted if a re-examination of my information suggests something that may be relevant to my own health, and I authorize GenSec to retain my information in identifiable form for this purpose.
☐ I do not agree to this. I understand I may change my decision in the future.

Being contacted about research opportunities (optional)
If your information suggests you may be eligible for a research study, clinical trial, or registry, GenSec or your physician practice may wish to contact you about it. Being contacted is not a guarantee of eligibility or benefit, and any actual participation would require its own separate consent.

☐ I agree to be contacted about research opportunities that may be relevant to me.
☐ I do not agree to be contacted about research opportunities.