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Approved: April 5, 2018 Expiration Date: April 4, 2019 Stony Brook University IRB (CORIHS A)RESEARCH PERMISSION FORM NONTRANSPLANT TISSUE BANK (Biobank) Project Title: NonTransplant Tissue Bank Principal

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Read the informed consent form thoroughly to understand the purpose, risks, benefits, and procedures involved.

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Ensure all sections of the form are completed accurately and truthfully.

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Sign and date the form to indicate your consent to participate in the activity or treatment.

04

If applicable, have a witness sign the form to confirm that you were provided with the necessary information and that you consented voluntarily.

Who needs informed consent in form?

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Any individual who is being asked to participate in a study, medical procedure, or activity that involves potential risks or benefits should fill out an informed consent form.

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This can include patients, research participants, students, and individuals participating in clinical trials.

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What is informed consent in form?

Informed consent in form is a document that indicates an individual has been fully informed about and understands the potential risks and benefits of a specific treatment or procedure.

Who is required to file informed consent in form?

Healthcare providers are required to file informed consent in form for their patients before performing any treatment or procedure.

How to fill out informed consent in form?

To fill out informed consent in form, the healthcare provider must ensure all the necessary information about the treatment or procedure is clearly explained to the patient or their legal representative, and the patient must sign the form indicating their understanding and agreement.

What is the purpose of informed consent in form?

The purpose of informed consent in form is to protect the rights and well-being of patients by ensuring they are fully informed about the treatment or procedure they are undergoing.

What information must be reported on informed consent in form?

The informed consent in form must include details about the treatment or procedure, potential risks and benefits, alternatives, and the patient's understanding and agreement.

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