VCU IRB PROTOCOL NUMBER: HM20018329
RESEARCH PARTICIPANT INFORMATION AND CONSENT FORM
ABOUT THIS CONSENT FORM
You are being invited to participate in a research study. It is important that you carefully think about whether being in this study is right for you and your situation.
This consent form is meant to assist you in thinking about whether or not you want to be in this study. Please ask the investigator or the study staff to explain any information in this consent document that is not clear to you. You may take home an unsigned copy of this consent form to think about or discuss with family or friends before making your decision.
Your participation is voluntary. You may decide not to participate in this study. If you do participate, you may withdraw from the study at any time. Your decision not to take part or to withdraw will involve no penalty or loss of benefits to which you are otherwise entitled.
AN OVERVIEW OF THE STUDY AND KEY INFORMATION
Why is this study being done?
What will happen if I participate?
CAN I STOP BEING IN THE STUDY?
You can stop being in this research study at any time. Leaving the study will not affect your medical care, employment status, or academic standing at VCU or VCU Health. Simply stop responding online and do not complete the survey.
HOW WILL INFORMATION ABOUT ME BE PROTECTED?
VCU and the VCU Health System have established secure research databases and computer systems to store information and to help with monitoring and oversight of research. Your information may be kept in these databases but are only accessible to individuals working on this study or authorized individuals who have access for specific research related tasks.
Information in these databases are not released outside VCU unless stated in this consent or required by law. Although results of this research may be presented at meetings or in publications, there is no collection of identifiable personal information in this project and individual responses will not be disclosed.
Personal information about you might be shared with or copied by authorized representatives from the following organizations for the purposes of managing, monitoring and overseeing this study:
- The study Sponsor, representatives of the sponsor and other collaborating organizations
- Representatives of VCU and the VCU Health System
- Officials of the Department of Health and Human Services
Project findings and reports prepared for dissemination will not contain information that can reasonably be expected to be identifiable.
The researchers cannot prevent you or others, for example a member of your family, from sharing information about you or your involvement in this research.
WHOM SHOULD I CONTACT IF I HAVE QUESTIONS ABOUT THE STUDY?
The investigator and study staff named below are the best person(s) to contact if you have any questions, complaints, or concerns about your participation in this research:
If you have general questions about your rights as a participant in this or any other research, or if you wish to discuss problems, concerns or questions, to obtain information, or to offer input about research, you may contact:
Virginia Commonwealth University Office of Research
800 East Leigh Street, Suite 3000, Box 980568, Richmond, VA 23298
(804) 827-2157; https://research.vcu.edu/human_research/volunteers.htm
Do not agree to participate in this study unless you have had a chance to ask questions and have received satisfactory answers to all of your questions.
STATEMENT OF CONSENT
I have been provided with an opportunity to read this consent form carefully. All of the questions that I wish to raise concerning this study have been answered. By agreeing to participate without providing my signature on this consent form I have not waived any of the legal rights or benefits to which I otherwise would be entitled. My participation indicates that I freely consent to participate in this research study. I can download a copy of the consent form for my records.
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