研究受试者知情同意书 - nyu school of medicine.docx

研究编号： 版本日期： 第 PAGE 9 页，共 NUMPAGES 9 页 版本日期：4/13/2018 研究受试者 知情同意书 研究标题： Insert Title of Research Study Insert Study Number 主研究员： Name of the Principal Investigator Department of Principal Investigator Applicable NYU School or College Address Phone Numbers 紧急联系人： Insert Emergency Contact Insert Phone Number/Pager, etc. 关于自愿参与本试验性研究 我们邀请您参与一项试验性研究。您的参与是自愿的，这意味着，您可以自行选择是否参与本研究。 同意参与此试验性研究的人被称作“受试者”或“研究受试者”。本同意书将会通篇使用这些称谓。在决定是否参与之前，您需要了解本研究的内容、参与本研究会有哪些风险和益处、以及您在本研究中需要做哪些事情。您也可以与您的家人、朋友或医生共同商讨本研究以及本同意书。如果您对本研究或本同意书有任何疑问，尽请管提出。如果您决定参与本研究，则必须签署本同意书。您将获得本同意书的已签名副本，以供您留存。 [NOTE TO RESEARCHERS: Reference is made to the NYU Langone Medical Center. For NYU researchers outside of the School of Medicine, make sure you replace School of Medicine text with the applicable NYU School or College and change the NYU logo above as appropriate. For various sections below that do not include standardized language text, see the companion document: Example Language for Non -Biomedical Informed Consent Form] All text in italics must be deleted from this document before submitting to the IRB 本研究的目的是什么？ FORMCHECKBOX Provide a concise explanation of the purpose of the research. 参与本研究需要多长时间？ 将有多少人参与本研究？ FORMCHECKBOX Provide expected duration of a subject’s involvement with the study FORMCHECKBOX Provide expected total duration of study. FORMCHECKBOX Provide the expected total number of subjects in study. FORMCHECKBOX Include number of subjects at NYULMC. (optional) [NOTE TO RESEARCHERS:?You may choose not to include the specific number of subjects at NYULMC IF?NYULMC is one of the sites of a multi-center study. This will?allow?you to minimize the number of required modifications to the consent form.]? 我在本研究中需要做什么？ FORMCHECKBOX Provide a high level overview of the major elements of the study and what is expected of the subject (i.e. note here only the major procedures and milestones). FORMCHECKBOX After the general overview, list each study visit separately and identify