Right to Decline Future Participation in Biological Sample Research

OHSU is a research institution. Research helps us learn ways to prevent or better treat diseases such as diabetes and cancer. You can decide whether to allow us to store and use your biological samples (such as tissue, blood, or body fluids) in medical research. For more information, see our frequently asked questions below.

You can decline biological sample donation by filling out this form and giving it to your health care provider at your next visit, or mail it to: 

Mail Code: OP17A
3181 SW Sam Jackson Park Road
Portland, OR 97239

Frequently asked questions

We sent you this form because:

  • You or a family member got care from OHSU or any of our clinics (Casey Eye Institute,  Doernbecher Children’s Hospital, etc.).
  • Your health care provider sent a sample to OHSU for testing.
  • Your health care provider referred you to OHSU.
  • You got a COVID vaccine given by OHSU (that means you can ignore this form).   

This notice tells you how your health information and biological samples MAY be used in future research (if you allow us to use it).  Research helps us learn how to better treat diseases such as diabetes and cancer.  If you want to let us use your information and samples for research, there is nothing you need to do. 

By law, OHSU sends this form all new patients who have or will receive care from OHSU.  

At times you may need to have a procedure, treatment or tests done as part of your care at OHSU. We may need to take biological samples (such as tissue, blood or body fluids) from you as part of the procedure, treatment or tests. If we have any leftover samples after using your biological samples for your care, you can choose to allow OHSU to store them for use in future research. OHSU can NOT use your samples or your personal information unless you let us.  If you do NOT want us to use your information and samples, just fill out and return this form. This is called opting out. 

We would use your leftover samples in tissue sample research and for anonymous or coded genetic research. For tissue sample research, we store your leftover sample for future research studies. For genetic research, we add extra protection to keep your personal information safe. We will use anonymous or coded research to protect your identity.  With anonymous research, your identity cannot be linked to your samples or health information.  With coded research, we keep your identity separate from your samples or health information. 

For more information about Oregon’s Genetic Privacy Laws visit www.healthoregon.org/genetics.

If you agree to allow your biological samples to be stored and used in future tissue or anonymous or coded genetic research, you do not need to do anything.  After 14 days, OHSU will mark your status as opt-in.

If you do NOT want to have your biological samples stored and used for future tissue or anonymous or coded genetic research, fill out the form and return it to OHSU.

Please note: Until we receive the opt-out form from you, OHSU will mark your status as opt-in 14 days after we send you the form.

Oregon’s Genetic Privacy Law requires OHSU to let patients opt-out of future research. Go to www.healthoregon.org/genetics for more information.

No, you cannot place conditions on future research.

If you still have questions, please call 503-494-8020 and leave a message.  We will call you back within 1-2 business days.