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Lydia Mendoza, LCSW Licensed Clinical Social Worker, LCS#: 18013 1015 23rd Street Sacramento, CA 95816 (916) 4435354RECEIPT AND ACKNOWLEDGMENT OF INFORMED CONSENT Name of Client(s): I have been provided

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How to fill out informed consent form

01

Start by reading the informed consent form thoroughly to understand its purpose and the information it requires.

02

Fill out the personal details section, providing accurate and up-to-date information about yourself.

03

Familiarize yourself with the study or procedure for which you are being asked to give consent. If there are any unfamiliar terms or concepts, seek clarification from the researcher or healthcare professional.

04

Carefully read and understand each section of the form, including the risks, benefits, and alternatives to the proposed study or procedure.

05

If you have any questions or concerns, do not hesitate to ask the researcher or healthcare professional to explain further.

06

Take your time to consider the information provided and ensure that you fully comprehend the implications of giving consent.

07

If you agree to participate or undergo the procedure, sign and date the form where indicated. It is essential to provide your voluntary and informed consent.

08

Keep a copy of the signed informed consent form for your records.

Who needs informed consent form?

01

Anyone who is participating in a research study or undergoing a medical procedure that requires their voluntary and informed consent needs an informed consent form.

02

This includes individuals of all ages, genders, and backgrounds. Informed consent forms are used to protect the rights and well-being of the participants by ensuring they have all the necessary information to make an informed decision.

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What is informed consent form?

An informed consent form is a document that outlines the details of a procedure or study, ensuring that participants are fully aware of the risks, benefits, and alternatives before agreeing to participate.

Who is required to file informed consent form?

Researchers and organizations conducting studies involving human subjects are required to file an informed consent form.

How to fill out informed consent form?

To fill out an informed consent form, provide accurate information about the study, explain the procedure, outline potential risks and benefits, and obtain the participant’s signature confirming their understanding and agreement.

What is the purpose of informed consent form?

The purpose of an informed consent form is to ensure that participants are adequately informed about the study they are enrolling in, protecting their autonomy and rights.

What information must be reported on informed consent form?

The informed consent form must report information such as the purpose of the study, procedures involved, risks and benefits, confidentiality assurances, and the right to withdraw from the study at any time.

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