Informed Consent Checklist (Please refer to DHS HHS OHRP 45 CFR 46 §46.116 for details) Basic Elements Indicate Yes No A statement that the study involves research An explanation of the purposes of the research The expected duration of the individual’s participation A description of the procedures to be followed Identification of any procedures which are experimental A description of any reasonably foreseeable risks or discomforts to the participant A description of any benefits to the participant or to others which may reasonably be expected from the research A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the participant A statement describing the extent, if any, to which confidentiality of records identifying the participant will be maintained For research involving more than minimal risk, an explanation as to whether any compensation, and an explanation as to whether any medical treatments are available, if injury occurs and, if so, what they consist of, or where further information may be obtained An explanation of whom to contact for answers to pertinent questions about the research and participant’s rights, and whom to contact in the event of a research-related injury to the participant A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the individual is otherwise entitled, and the individual may discontinue participation at any time without penalty or loss of benefits, to which he/she is otherwise entitled A statement that must contain the following language: description of “A the clinical trial will be available on , as required by U.S. Law. This Web site will not include information that can identify you.
Informed Consent Checklist (Please refer to DHS HHS OHRP 45 CFR 46 §46.116 for details) Basic Elements Indicate Yes No A statement that the study involves research An explanation of the purposes of the research The expected duration of the individual’s participation A description of the procedures to be followed Identification of any procedures which are experimental A description of any reasonably foreseeable risks or discomforts to the participant A description of any benefits to the participant or to others which may reasonably be expected from the research A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the participant A statement describing the extent, if any, to which confidentiality of records identifying the participant will be maintained For research involving more than minimal risk, an explanation as to whether any compensation, and an explanation as to whether any medical treatments are available, if injury occurs and, if so, what they consist of, or where further information may be obtained An explanation of whom to contact for answers to pertinent questions about the research and participant’s rights, and whom to contact in the event of a research-related injury to the participant A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the individual is otherwise entitled, and the individual may discontinue participation at any time without penalty or loss of benefits, to which he/she is otherwise entitled A statement that must contain the following language: “A description of the clinical trial will be available on , as required by U.S. Law. This Web site will not include information that can identify you.
Informed_Consent_Checklist_07-17-2015.docx