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Emmy Participant Consent Form

This document is a participant consent form for an epidemiological study on the prevalence of Cryptococcal Meningitis in immunocompromised patients in Choma District. It outlines the voluntary nature of participation, the right to withdraw, confidentiality assurances, and the handling of personal information. Participants acknowledge understanding the study's purpose and potential risks before agreeing to take part.

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Samuel Ndumba
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9 views1 page

Emmy Participant Consent Form

This document is a participant consent form for an epidemiological study on the prevalence of Cryptococcal Meningitis in immunocompromised patients in Choma District. It outlines the voluntary nature of participation, the right to withdraw, confidentiality assurances, and the handling of personal information. Participants acknowledge understanding the study's purpose and potential risks before agreeing to take part.

Uploaded by

Samuel Ndumba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Participant Consent Form

An epidemiological study of the prevalence of Cryptococcal Meningitis in


immunocompromised patients in Choma District

I have read (or been explained to) the information sheet concerning the study and I have
understood what it is all about. All the questions have been answered to my satisfaction. I
understand that I am free to request further information at any stage.
Further, the researcher has explained to my satisfaction the purpose of the study and the possible
risks involved.
I know that:
 My participation in the project is entirely voluntary.
 I am free to withdraw from the investigation or project at any time I so wish without any
penalty and I am free not to answer questions that may compromise the patient’s
confidentiality.
 Any information about me will not have identifiers and will be destroyed at the end of the
project and that any confidential information will be seen only by the researchers and will not
be revealed to anyone else without my consent.
 The results of the research may be published or used for reports but I will not be identified.

I agree to take part in this project

............................................. ..................................... .........................


Initials Signature/Thumb print Date

............................................ .................................... .............................


Researcher Signature Date

Contact telephone Number.............................................

........................................... ......................................... ............................


Witness Signature/Thumb print Date

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