SUO_NSG6101_Informed_Consent_Letter.edited x
INFORMED CONSENT LETTER
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For Official Use Only |
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Received on: |
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Reviewed on: |
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End date: |
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File Number: |
LETTER OF SELF CONSENT
I acknowledge the invitation to take part in a research investigation named: How the use of standard face mask compares with the use respiratory face mask in regard to high exposure to Covid-19 virus.
This investigation is spearheaded by landyrinn17: whose contact information includes:
XXx@gmail.com
, xx-xx-xx.
I am aware that the participation in this research study is on a voluntary basis, and I am free to object the invitation as well as to withdraw my involvement as I would deem fit without offering any reason, getting victimized, or facing any legal suit or conviction. It is also my right to ask for the withdrawal, return, or discarding of any of the information shared or collected following my participation in the study.
PURPOSE OF THIS RESEARCH INVESTIGATION
I am aware that this study aims at:
Determining how efficient are both the respiratory mask as well as standard mask in preventing healthcare providers from getting exposed to corona virus in the course of their work. Can they all be relied to offer the same protection?
PROCEDURES
I acknowledge that in case I agree to participate in this investigation, I will be requested to:
Declare information related to chronic illness or preexisting conditions as well as my age. I will as well be required to fully adhere to the recommended hygiene standards as well as to be fully dressed with protective gears which include the designated face mask, prior to getting exposed to SARS- COV – 2 viruses. Also, I will have to undertake a 14 day or more in quarantine as well as undertake the COVID 19 test. I shall also be required to undertake necessary treatments in the event I am exposed to the virus.
BENEFITS
I am aware that I will be receiving the following benefits following my participation in this study:
I will get a chance to enhance the safety of healthcare providers’ who continue to dedicate their efforts to the treatment and care of COVID_19 patients and relies on face masks as one of their PPE. I will assist them in understanding if they would still use the standard face masks, taking into consideration the general shortage of respiratory masks. All the instruments to be used and expenses incurred will be covered by the researcher together with any counseling and treatments in case I am exposed to the virus.
RISKS
I acknowledge that my participation in this study may expose me to the following negative outcomes:
I understand that I may get exposed to the virus, become sick, or even die from the COVID 19 disease. Due to the gravity of the illness, I may also be psychologically affected.
CONFIDENTIALITY
I understand that my personally identifiable information and participation information shall and will be treated with the utmost confidentiality. Any sharing of such information must get my prior authorization as provided in the HIPAA act and other related regulations.
ANY OTHER QUESTIONS
I am aware that in case I need clarification on any issue above or have any concern now, during the participation period, or afterward, I am and will be free to address it to the researcher ( landyryn17 ).
Besides, I acknowledge that I can as well direct any issue or concerns that pertain to my participatory rights to Dr. J . Hillyer, the Director of training and compliance at South University, 7700 W. Parmer Ln., Austin, TX 78729; 512-516-8779,
jhillyer@southuniversity.edu
;
I append the below signature to ascertain that the researchers have sufficiently addressed every question I had, having understood the purpose, benefits, procedures, risks, and confidentiality and rights clauses described herein. I have as well retained a duplicate of this form for my documentation.
Name of the Participant
Participants Signature Date (dd/mm/yyyy)
Principal Researcher Signature Date (dd/mm/yyyy)
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