Use this form if you are requesting one or more of the following: (a) a waiver of the requirement for written documentation of consent, (b) a waiver of the requirement for consent, (c) a partial waiver or alteration of consent, (d) use of the “short form” consent process.
This document is for use with paper-based applications only. Do not use with Zipline. HSD accepts versions from 3/27/2015 on.
Revised instructions to describe email submission process – 03.12.2020
Updated links – 05.09.2017