Patient Informed Consent Form

Title

A developmental study in testing the developed drug's efficacy against the virus  causing pneumonia

What is the aim of the study?

The aim of this study is to try whether the drug developed is a cure that will cure persons with having the condition of pneumonia due to a virus. This new drug is cheaper and is supposed to be more effective using the conventional method which is more expensive.

How many people will be recruited?

In this study, we are aiming to recruit 300 people based on various hospitals within the region in order to validate the efficacy of the drug.

What are the prerequisites for patient’s participating?

In order for the patient to qualify, he or she must have tested positive of the condition or disease. If the candidate is a female, she should not be pregnant at the time she is participating in this study. Lastly, he or she must sign this informed consent form.

Research process

Upon signing this agreement, the patients will be given the drug and shall take it orally 3x per day. Blood, saliva, and stool samples will be collected from the patient periodically in order to test the progress of the drug.

Risk in participating in this study

The possible risk that might occur is that the drug will not cure the disease if it turns out ineffective. No other known risks are apparent and the patient may still be able to be cured using the old but more expensive method available.

Advantages to patients

In participating, the patient can get treated of the disease without extra cost, other than the usual clinical maintenance and therapeutic costs.

Compensation

Participating in this study will not have any compensation. The tests and treatment; however, are free.

Confidentiality

We guarantee that all information in this study will not be disclosed to anyone without your consent, except to the members of the research team, your physician, and the medical staff of this institution who may be able to access your information incidental to the performance of their duties. Should we publish a journal involving your condition, we will ask for your consent whether you will be named or be treated anonymously. 

Rights of the patients

Considering that participation in this study is voluntary, the participating patient may withdraw from this study at any time.

Who to ask if there are questions or concerns?

Should the participant have questions, please contact the Research Unit Director:

Name: Dr. Calvin A. Hobbs
Phone: 309-233-4012

I have read and explained the details of this informed consent to the undersigned patient. I have given the opportunity for the patient to ask his/her questions. All questions raised by the patient were answered by me to the satisfaction of the patient.