Get the free Statement of Informed Consent - The National Association of County bb - naccho

Statement of Informed Consent for Health Promotion Survey Purpose of the Project The Multnomah County Health Department is surveying clients to learn about their health promotion needs. This project

How to fill out statement of informed consent

How to fill out a statement of informed consent:

1. Start by clearly identifying the title of the document, such as "Statement of Informed Consent" at the top of the page.
2. Include a brief introduction explaining the purpose of the statement and what it entails. This can include information about the study, procedure, or activity for which the consent is being obtained.
3. Begin with the participant's information section. This should include their full name, age, contact details, and any other relevant information necessary for identification.
4. Provide a clear and concise description of the study or activity, outlining its purpose, objectives, and procedures. Use simple language that the participant can easily understand. Avoid using jargon or technical terms if possible.
5. Include a section that explains the potential risks and benefits associated with participating in the study or activity. Be honest and transparent about the potential risks involved, as well as any potential benefits that the participant may receive.
6. Clearly outline the participant's rights and responsibilities. This can include information about their right to withdraw from the study at any time, their right to ask questions and receive clarification, and their responsibility to adhere to any guidelines or protocols outlined in the study.
7. Include a section for the participant to indicate their consent. This can be in the form of a checkbox, signature, or initials. Make sure that the participant understands that their consent is voluntary and that they have the right to decline or withdraw at any time.
8. Provide contact information for any questions or concerns the participant may have. Include the name, phone number, and email address of a contact person who can address any queries or provide additional information.

Who needs a statement of informed consent:

1. Researchers: In any scientific or academic research study involving human participants, researchers need to obtain informed consent to ensure that participants understand the nature of the study and voluntarily agree to participate.
2. Medical practitioners: Before conducting any medical procedure or treatment, healthcare professionals must obtain informed consent from the patient or their authorized representative, outlining the risks, benefits, and alternatives to the proposed intervention.
3. Organizations or institutions: Any organization or institution that engages in activities involving potential risks for participants, such as sports clubs or adventure tourism companies, may require participants to sign a statement of informed consent to acknowledge and accept the potential risks involved.

Note: The requirements for a statement of informed consent may vary depending on the country, jurisdiction, or specific field of study or activity. It is recommended to consult with legal and ethical guidelines applicable to your specific context to ensure compliance.

For pdfFiller’s FAQs

What is statement of informed consent?

Statement of informed consent is a document that provides detailed information to individuals about a specific procedure, treatment, or research study, allowing them to make an informed decision and give their voluntary consent.

Who is required to file statement of informed consent?

Typically, researchers, healthcare professionals, or organizations conducting a study or providing a treatment procedure are required to file the statement of informed consent.

How to fill out statement of informed consent?

The statement of informed consent can be filled out by including relevant and accurate information about the procedure or study, the potential risks and benefits, alternatives, confidentiality, participant rights, and contact information of the responsible party. It should be written in clear and understandable language for the participants.

What is the purpose of statement of informed consent?

The purpose of the statement of informed consent is to ensure that individuals are fully informed about the procedure or study, including its potential risks and benefits, so that they can make an autonomous decision regarding their participation. It also serves to protect the rights and welfare of participants.

What information must be reported on statement of informed consent?

The statement of informed consent should include information about the purpose of the procedure or study, the procedures involved, the potential risks and benefits, any alternatives, confidentiality measures, participant rights, contact information, and any compensation or incentives offered.

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