This one-page consent form helps to faciliate consent and promote broad genomic data sharing in the clinical setting. The language use on the form is consistent with the NIH Genomic Data Sharing Policy and the NHGRI Informed Consent Resource. The consent form was developed by the Clinical Genome Resource (ClinGen), a not-for-profit, National Institutes of Health (NIH)-funded resource dedicated to sharing genetic data, building knowledge, and improving patient care. The file contains two pages; one with the ClinGen logo in the bottom corner and the other without the logo.

This form is for physicians to record demographic and clinical information about a patient to facilitate laboratory interpretation of whole exome sequencing results. It also records family history of cancer and physician choice about receipt of carrier status information for autosomal recessive conditions.