Example 1 of 3
You are invited to be in a research study to test the safety and
effectiveness of a new drug called ________. It is a new antibiotic (germ
killer). You are being asked to be in the study because you have signs
and symptoms of having pneumonia.
This consent form may contain words that you do not understand. Please
ask Dr. ______ or the study nurse to explain any words or information that
you do not understand.
Example 2 of 3
Before you can decide
whether or not to volunteer for this study, you must understand the
purpose, how it may help you, any risks you take, and what is expected of
you. We ask that you read this form and ask any questions you may have
before agreeing to be in the study.
Example 3 of 3
You are being asked to take part in a research study for patients with
cancer. It is important that you read and understand several general
principles that apply to all who take part in this study: (a) taking part
in the study is entirely voluntary; (b) personal benefit may not result
from taking part in the study, but knowledge may be gained that will
benefit others; (c) any significant new findings that relate to your
treatment will be discussed with you; (d) you may withdraw from the study
at any time without penalty or loss of any benefits to which you are
otherwise entitled. The nature of the study, the risks, inconveniences,
discomforts, and other pertinent information about this study are
discussed below. You are urged to discuss any questions you have about
this study with the staff members who explain it to you.