The University of Chicago Allergy/Immunology Research Registry is a database that is made up of people who have volunteered to consider participation in research studies for themselves or their children. The protected health information (PHI) elements that will be collected are name, address, phone number email, and date of birth. This information will be used to determine whether you qualify for future research studies and to contact you to request your participation. The information that you provide will be kept in a secure database and will not be distributed. The allergy/immunology team will be the only individuals to have access and reach out to you for any research study participation. Your authorization to use and disclose your health information does not have an expiration date. The University of Chicago/University of Chicago Medical Center will not condition (withhold or refuse) treating you on whether you sign this authorization or revoke your authorization at a later time. Once information is shared outside the University of Chicago, please note that your identifiable health information may be shared with someone else. The same laws that the University of Chicago must obey may not protect your health information. If you do not sign this form, we will not contact you for research studies.

Its goal is to quickly and efficiently bring together medical research and those who may benefit from medical research. Although this Registry is sponsored by the University of Chicago, neither you nor your child need be a patient at the University of Chicago to sign up for the Registry. You may revoke your participation to this research registry at any time.

Please note that if you are registering on behalf of your child, your child's information will be automatically removed from the Registry when he/she turns 18. Your child may choose to reregister when he/she turns 18. If you have any questions about this Registry, please call 773-702-8137.

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