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Research Informed Consent Form

This document is a Research Informed Consent Form inviting teachers to participate in a clinical study on viral infections. The research aims to understand how viruses spread and transfer between hosts, involving the collection of various biological samples from participants. Participation is voluntary, incurs no additional costs, and ensures confidentiality and the right to withdraw at any time.

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Arjay Diokno
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1 views

Research Informed Consent Form

This document is a Research Informed Consent Form inviting teachers to participate in a clinical study on viral infections. The research aims to understand how viruses spread and transfer between hosts, involving the collection of various biological samples from participants. Participation is voluntary, incurs no additional costs, and ensures confidentiality and the right to withdraw at any time.

Uploaded by

Arjay Diokno
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Research Informed Consent Form

A Research for
Teachers’ Awareness and Sensitivity of School on Child Protection Policy:
Basis for Intervention Scheme

Dear teacher:
Thank you for this opportunity for taking the time in discussing with you about our clinical research. We
believe that the condition that you have is one of the conditions that we are looking for in our research.
We would like to invite you to participate in this clinical research on understanding the Viral Infection on
human hosts. We wish for you to please carefully read this research informed consent form and sign at
the bottom of the form should you wish to take part in this clinical study.
Our research doctors are available should you have questions. You can also ask your physician regarding
this study. We recommend as well that you ask your family and friends before you take part in this clinical
study.

Purpose

The aim of this research is to understand the virus on how it spreads within the host as well as to
understand how the infection transfers from one host to another.

Participants

We intend to recruit 400 people having been inflicted with the disease or of the same condition. This may
be within the same hospital or from various hospitals. There will be a central registration and this shall be
monitored by the health department.

Requirements

Before a participant can take part in this program, he or she must:

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1. Have the disease or condition which the program sought for addressing;
2. Have signed this Informed Consent Form.

The Process

This research intends to mainly collect specimens from everyone and to be able to understand the
disease. The researchers will collect blood, saliva, and stool samples from all patients and in both
asymptomatic and those manifesting conditions. Blood and urine samples shall be collected periodically.

Risks in Participation

There are no risks in participating in this research. This research does not in any way interfere with the
treatment and diagnosis of the patient.

Advantages

In participating in this research, the patients can get thorough and detailed information about their
condition and the relevant progress on the research. Their condition shall be better monitored throughout
the period of recovery.

Cost

Participating in this research shall not incur any additional cost to the patient. Only costs on diagnostic
and therapeutic expenses shall be incurred.

Confidentiality Agreement

The research committee understands and respects the privacy of each and every individual. We guarantee
that the information gathered through this research shall never be sold, shared, or disclosed to anyone
without the consent of the patient participant. The participant has the right to his information including the
right to share his or her information in journals. We may still continue to share the information as to our
findings based on the participant's information but without disclosing the personal information of the said
participant.

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Rights of Participant

We respect the rights and privacy of the participant. Given this research is voluntary in nature, the
participant may withdraw from the research at any time.

Questions

If you have questions relating to this program you may contact our research head:
Name: Dr. Edward Spengler
Phone: 4-4678-287837

CONSENT

I have read the information above and I have been oriented by the researcher with the research related to
this consent. I was given the opportunity and have asked the relevant questions to this research and the
questions were answered accordingly and to my satisfaction by the researcher. As a participant, I fully
understand that this consent is voluntary, and in no way, I was threatened or convinced to participate under
duress.
I am aware that in any case, I feel inconvenient to continue with my participation in this research, I may
withdraw from my participation at any time.

Please check below if necessary


I am of legal age but I wish for a representative to sign on my behalf.
I am below legal age. My parent/guardian will sign on my behalf.
I wish for a witness to sign this consent

Name *

Prefix First Name Middle Name Last Name

Representative

First Name Last Name

Legal Parent/Guardian

First Name Middle Name Last Name


3

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Prefix

Date

Month Day Year

Witness

First Name Middle Name Last Name

Date

Month Day Year

I affirm that informed consent has been explained to the participant clearly to the best of my knowledge. I
have given the opportunity to the participant to ask questions he or she raised and by which I have
answered them to the participant's satisfaction. I certify that the participant has already understood the
information, including his or her rights, and agreed to participate in this research.

Number of Research Doctors that will sign this informed consent *


Please Select

Name of Researcher

First Name Middle Name Last Name

Date

Month Day Year

Name of Researcher

Prefix First Name Middle Name Last Name

Date

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Day Year

Name of Researcher

Prefix First Name Middle Name Last Name

Date

Month Day Year

Submit
Submit

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