Authorized Study Enrollment Workflow

Consultant quick path

Three steps: select site, populate packet, download one PDF.

Select provider/siteAutofills site and consentor fields.
Enter patient + release itemsPatient fields populate all 3 packet documents; checked release items populate the Medical Release list.
Preview + download packetUse one filled wet-signature PDF, then scan/upload the signed packet to Google Drive.

Review source documents

Step 1 — SpectOcular Patient Services ConsentPDF source document with Section 18 e-signature/wet-signature workflow populated from the packet fields.Step 2 — Medical ReleaseGenerated medical-release PDF with a blank Information to be Released section that is populated from the checked boxes below.Step 3 — Research Consent / HIPAA AuthorizationUploaded approved research consent / HIPAA authorization PDF.

Pilot record rule: Print and obtain wet-ink signatures. Scan the completed packet to PDF and upload only to the restricted Google Drive signed-packet folder. Do not email PHI or signed packets unless approved encrypted email procedures are in place.

Google Drive Packet Folder URL: This is the restricted Google Drive folder where the signed attestation packet PDF will be uploaded after wet signatures.

Step 1 — SpectOcular Patient Services Consent PDF preview

Preview of the PDF source. The downloaded packet replaces Section 18 with a larger signature/e-signature page populated from the website fields.

Open Patient Services Consent PDF

Step 2 — Medical Release source PDF preview

The generated packet creates a clean Medical Release PDF with the Information to be Released list intentionally blank until the checked website items populate that section.

Open Medical Release PDF

Step 3 — Research Consent / HIPAA Authorization source PDF preview

Preview of the approved research consent/HIPAA source. The generated packet uses a cleaned signature page populated from the website fields.

Open Research Consent / HIPAA PDF

Medical Release Categories

Select the categories to populate the blank “Information to be Released” section in the Medical Release PDF included in the filled wet-signature packet.

Populate packet fields

Site autofill: Select a site/provider to populate site number, OD/consentor fields, notification routing, and Google backend site fields. Add future sites in the Google backend Sites tab — no website rebuild required.

Site

Selected Site ID

Patient First Name

Patient Last Name

Clinic Patient ID / Medical Record Identifier

Date of Birth

Email Address

Street Number and Street Name

City

State

ZIP

Phone Number

Preferred Communication Method

PCP First Name, if known

PCP Last Name, if known

PCP Phone / Fax, if known

Street Number and Street Name

PCP City

PCP State

PCP ZIP

Pharmacy Name

Pharmacy Phone / Fax

Street Number and Street Name

Pharmacy City

Pharmacy State

Pharmacy ZIP

OD / Site First Name

OD / Site Last Name

Consentor Role

Consentor First Name

Consentor Last Name

Study Subject Identifier

Format: two-digit site number + five-digit sequential subject number. Example: 01-00001. For the pilot, update the restricted Master Linkage sheet as each subject is enrolled so it remains the source of truth.

Site Number

Subject Sequence Number

Generated Subject ID

Local tracker: No subject number has been saved for this site in this browser. This browser tracker is only a convenience; the restricted Master Linkage sheet remains the source of truth.

Signature / Enrollment Date

Secondary Identifier / Notes

Step 1 e-signature box

SpectOcular Patient Services Consent — Section 18 e-signature

Use these fields when the SpectOcular Patient Services Consent will be electronically signed from this workflow. The Medical Release and Research Consent/HIPAA packet will still print with wet-signature lines unless separately approved for e-signature.

Patient Typed / Electronic Signature

Patient E-Sign Date/Time

I agree that my typed/electronic signature is legally effective for the SpectOcular Patient Services Consent.

Consentor Typed / Electronic Signature

Consentor E-Sign Date/Time

I agree that my typed/electronic signature documents that I facilitated the consent process and verified identity for the SpectOcular Patient Services Consent.

Live PDF signature preview

Verify the final signature pages before printing.

These previews use the same labels, sequence, and wording as the generated wet-signature packet. The Medical Release list remains blank until categories are checked above.

SpectOcular LLCSubject ID: —

SpectOcular Patient Services Consent — Patient Information and Signature

Patient First Name—

Patient Last Name—

Date of Birth—

Clinic Patient ID / MRN—

By signing below, I acknowledge that I have read this Practice Consent or had it read to me; I had the opportunity to ask questions; I understand that this Practice Consent is separate from any research consent; and I authorize the use and disclosure of my information as described in this Practice Consent.

Patient signature line / typed e-signaturePatient Signature / E-Signature

—Date / Time

Consentor signature line / typed e-signatureConsentor Signature / E-Signature

Consentor Printed Name—

Consentor Role—

SpectOcular LLCSubject ID: —

Authorization for Release of Medical Records

Patient First Name—

Patient Last Name—

Date of Birth—

Information to be Released

No release categories selected.

I authorize the release of the selected medical information categories for the purposes stated in the Medical Release.

Patient signature line / typed e-signaturePatient Signature / E-Signature

—Date / Time

Consentor signature line / typed e-signatureConsentor Signature / E-Signature

Consentor Printed Name—

Consentor Role—

SpectOcular LLCSubject ID: —

Participant Statement and Authorization — Signature Page

I have read or have had read to me the Participant Informed Consent Form and Authorization to Use and Disclose Medical Information and I agree to participate voluntarily in this study.

Printed Name of Participant—

Signature of Participant

—Date

Printed Name of Person Explaining Consent / Consentor—

Signature of Person Explaining Consent / Consentor

—Date

ID verifiedNo

Back

Google Drive upload + master linkage

After signatures, upload the signed packet and notify central staff.

Download packetUse one completed PDF packet with all required consent/release documents.
Upload signed packetSave the final scanned signed packet to the restricted signed-packet Google Drive folder.
Notify central teamUse the no-PHI email button with Subject ID only when central review is needed.

Google Drive Packet Folder URLThis is the restricted BAA-covered Drive folder where the final signed attestation packet PDF is uploaded.

Master Linkage Sheet URLUse this sheet as the source of truth for the last patient/subject number used at each site.

Uploaded Packet Link

Central Review Status

SpectOcular Notification Email

Notification Type

Filled wet-signature packet PDF created. Obtain signatures, scan/upload the signed PDF to restricted Google Drive, and notify central staff.

Authorized Study Enrollment Workflow

Three steps: select site, populate packet, download one PDF.

Review source documents

Medical Release Categories

Populate packet fields

Study Subject Identifier

Identity verified — no ID image retained.

SpectOcular Patient Services Consent — Section 18 e-signature

Verify the final signature pages before printing.

SpectOcular Patient Services Consent — Patient Information and Signature

Authorization for Release of Medical Records

Information to be Released

Participant Statement and Authorization — Signature Page

After signatures, upload the signed packet and notify central staff.