Research Informed Consent Form

A Research for Clinical Studies on
Understanding the Viral Infection on Humans

Dear Candidate:

Thank you for this opportunity for taking the time in discussing with you about our clinical research. We believe that the condition that you have is one of the conditions that we are looking for in our research. We would like to invite you to participate in this clinical research on understanding the Viral Infection on human hosts. We wish for you to please carefully read this research informed consent form and sign at the bottom of the form should you wish to take part in this clinical study.

Our research doctors are available should you have questions. You can also ask your physician regarding this study. We recommend as well that you ask your family and friends before you take part in this clinical study.

The aim of this research is to understand the virus on how it spreads within the host as well as to understand how the infection transfers from one host to another. 

We intend to recruit 400 people having been inflicted with the disease or of the same condition. This may be within the same hospital or from various hospitals. There will be a central registration and this shall be monitored by the health department.

Before a participant can take part in this program, he or she must:

1. Have the disease or condition which the program sought for addressing;
2. Have signed this Informed Consent Form.

This research intends to mainly collect specimens from everyone and to be able to understand the disease. The researchers will collect blood, saliva, and stool samples from all patients and in both asymptomatic and those manifesting conditions. Blood and urine samples shall be collected periodically.

There are no risks in participating in this research. This research does not in any way interfere with the treatment and diagnosis of the patient.

In participating in this research, the patients can get thorough and detailed information about their condition and the relevant progress on the research. Their condition shall be better monitored throughout the period of recovery.

Participating in this research shall not incur any additional cost to the patient. Only costs on diagnostic and therapeutic expenses shall be incurred. 

The research committee understands and respects the privacy of each and every individual. We guarantee that the information gathered through this research shall never be sold, shared, or disclosed to anyone without the consent of the patient participant. The participant has the right to his information including the right to share his or her information in journals. We may still continue to share the information as to our findings based on the participant's information but without disclosing the personal information of the said participant.

We respect the rights and privacy of the participant. Given this research is voluntary in nature, the participant may withdraw from the research at any time.

If you have questions relating to this program you may contact our research head:

Name: Dr. Edward Spengler
Phone: 4-4678-287837

I have read the information above and I have been oriented by the researcher with the research related to this consent. I was given the opportunity and have asked the relevant questions to this research and the questions were answered accordingly and to my satisfaction by the researcher.  As a participant, I fully understand that this consent is voluntary, and in no way, I was threatened or convinced to participate under duress. 

I am aware that in any case, I feel inconvenient to continue with my participation in this research, I may withdraw from my participation at any time.

I affirm that informed consent has been explained to the participant clearly to the best of my knowledge. I have given the opportunity to the participant to ask questions he or she raised and by which I have answered them to the participant's satisfaction. I certify that the participant has already understood the information, including his or her rights, and agreed to participate in this research.