Informed Consent would like to thank you for participating in this study. The purpose of this study is to Test Company evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about minutes. At the 60 conclusion of the test, you will be compensated for your time. Agreement I understand and that as a voluntary participant in the present study conducted by I am Test Company free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by I understand that the Test Company. information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by without further permission. Test Company I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and client. I understand and agree that data confidentiality is assured, because only de- Test Company’s identified data i.e., identification numbers not names will be used in analysis and reporting of the – – results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please one of the following: YES, I have read the above statement and agree to be a participant.  NO, I choose not to participate in this study.  Signature: Date:
Informed Consent Test Company would like to thank you for participating in this study. The purpose of this study is to evaluate an electronic health records system. If you decide to participate, you will be asked to perform several tasks using the prototype and give your feedback. The study will last about 60 minutes. At the conclusion of the test, you will be compensated for your time. Agreement I understand and that as a voluntary participant in the present study conducted by Test Company I am free to withdraw consent or discontinue participation at any time. I understand and agree to participate in the study conducted and videotaped by the Test Company. I understand and consent to the use and release of the videotape by Test Company. I understand that the information and videotape is for research purposes only and that my name and image will not be used for any purpose other than research. I relinquish any rights to the videotape and understand the videotape may be copied and used by Test Company without further permission. I understand and agree that the purpose of this study is to make software applications more useful and usable in the future. I understand and agree that the data collected from this study may be shared with outside of Test Company and Test Company’s client. I understand and agree that data confidentiality is assured, because only de- identified data – i.e., identification numbers not names – will be used in analysis and reporting of the results. I agree to immediately raise any concerns or areas of discomfort with the study administrator. I understand that I can leave at any time. Please one of the following:  YES, I have read the above statement and agree to be a participant.  NO, I choose not to participate in this study. Signature: Date:
NIST%207742%20User%20Centered%20Design%20WORD%20Format.docx