OMB #: 0925 -0216
Expiration Date: xx/xxxx
DRAFT RESEARCH CONSENT FORM- PENDING IRB APPROVAL |
Offspring Exam 9 |
|
H-22762 - THE FRAMINGHAM HEART STUDY N01-HC-25195 1910G |
|
Background |
You are being asked to participate in the 8th Framingham Heart Study Offspring examination. This is an observational study designed to identify the relationship between risk factors, genetics, cardiovascular disease, and other health conditions. |
|
|
|
Purpose |
The purpose of this research study is to 1) investigate factors related to the development of heart and blood vessel diseases, lung and blood diseases, stroke, memory loss, cancer, and other diseases and health conditions; and 2) examine DNA and its relationship to the risks of developing these diseases and health conditions. This examination does not take the place of a routine medical check up by your physician. |
|
What Happens In This Research Study |
You will be one of approximately
3800 subjects to be asked to participate in this study. |
|
Your research examination will take
place at the Framingham Heart Study facility located at 73 Mount
Wayte Avenue in Framingham, MA or other facility/residence. |
|
Risks and Discomforts |
Each of the test procedures and
their risks and discomforts are listed below: |
|
There may be unknown risks/discomforts involved. Study staff will update you in a timely way on any new information that may affect your health, welfare, or decision to stay in this study |
|
Potential Benefits |
You will receive no direct benefit from your participation in this study. However, your participation may help the investigators better understand the precursors, etiology, and prevention of cardiovascular disease and other health conditions, including the possibility of genetic linkages. |
|
Alternatives |
Your alternative is to not participate in the study. |
|
Subject Costs and Payments |
You will not be charged for any
part of the examination. If the examination uncovers any medical
problems that require medical diagnosis or treatment, you will be
so advised and that information will be provided to the physician
or clinic that you choose. |
|
Confidentiality |
Any
information we obtain about you during this study will be treated
as strictly confidential to the full extent permitted by
applicable law. To ensure confidentiality, a code number will be
assigned to you and your potentially identifying information.
|
|
Subject's Rights |
By consenting to participate in
this study you do not waive any of your legal rights. Giving
consent means that you have heard or read the information about
this study and that you agree to participate. You will be given a
copy of this form to keep. |
|
Compensation for Research Related Injury |
If you think that you have been injured by being in this study, please let the investigator know right away. If your part in this study takes place at Boston Medical Center, you can get treatment for the injury at Boston Medical Center. If your part in the study is not at Boston Medical Center, ask the investigator where treatment for injury would be available locally. You and your insurance company will be billed for this treatment. Some research sponsors may offer a program to cover some of the treatment costs which are not covered by your insurance. You should ask the research team if such a program is available. |
|
Right to Refuse or Withdraw |
Taking part in this study is voluntary. You have the right to refuse to take part in this study. If you decide to be in the study and then change your mind, you can withdraw from the research. Your participation is completely up to you. Your decision will not affect your being able to get health care at this institution or payment for your health care. It will not affect your enrollment in any health plan or benefits you can get. If you choose to take part, you have the right to stop at any time. If there are any new findings during the study that may effect whether you want to continue to take part, you will be told about them as soon as possible. The investigator may decide to discontinue your participation without your permission because he/she may decide that staying in the study will be bad for you, or the sponsor may stop the study. |
|
DRAFT
Offspring Exam 9 PENDING IRB APPROVAL |
DRAFT RESEARCH CONSENT FORM – PENDING IRB APPROVAL |
Offspring Exam 9 – Offsite OMB NO=0925-0216 03-08-2010 |
|
H-22762 - THE FRAMINGHAM HEART STUDY N01-HC-25195 1910G |
|
Background |
You are being asked to participate in the 8th Framingham Heart Study Offspring examination. This is an observational study designed to identify the relationship between risk factors, genetics, cardiovascular disease, and other health conditions. |
|
|
|
Purpose |
The purpose of this research study is to 1) investigate factors related to the development of heart and blood vessel diseases, lung and blood diseases, stroke, memory loss, cancer, and other diseases and health conditions; and 2) examine DNA and its relationship to the risks of developing these diseases and health conditions. This examination does not take the place of a routine medical check up by your physician. |
|
What Happens In This Research Study |
You will be one of approximately
3800 subjects to be asked to participate in this study. |
|
Your research examination will take
place at 73 Mount Wayte Avenue in Framingham, MA or other
facility/residence. |
|
Risks and Discomforts |
Each of the test procedures and
their risks and discomforts are listed below: |
|
|
|
There may be unknown risks/discomforts involved. Study staff will update you in a timely way on any new information that may affect your health, welfare, or decision to stay in this study |
|
Potential Benefits |
You will receive no direct benefit from your participation in this study. However, your participation may help the investigators better understand the precursors, etiology, and prevention of cardiovascular disease and other health conditions, including the possibility of genetic linkages.. |
|
Alternatives |
Your alternative is to not participate in the study. |
|
Subject Costs and Payments |
You will not be charged for any
part of the examination. If the examination uncovers any medical
problems that require medical diagnosis or treatment, you will be
so advised and that information will be provided to the physician
or clinic that you choose. |
|
Confidentiality |
Any information we obtain about you
during this study will be treated as strictly confidential to the
full extent permitted by applicable law. To ensure
confidentiality, a code number will be assigned to you and any of
your potentially identifying information. |
|
Subject's Rights |
By consenting to participate in
this study you do not waive any of your legal rights. Giving
consent means that you have heard or read the information about
this study and that you agree to participate. You will be given a
copy of this form to keep. |
|
Compensation for Research Related Injury |
If you think that you have been injured by being in this study, please let the investigator know right away. If your part in this study takes place at Boston Medical Center, you can get treatment for the injury at Boston Medical Center. If your part in the study is not at Boston Medical Center, ask the investigator where treatment for injury would be available locally. You and your insurance company will be billed for this treatment. Some research sponsors may offer a program to cover some of the treatment costs which are not covered by your insurance. You should ask the research team if such a program is available. |
|
Right to Refuse or Withdraw |
Taking part in this study is voluntary. You have the right to refuse to take part in this study. If you decide to be in the study and then change your mind, you can withdraw from the research. Your participation is completely up to you. Your decision will not affect your being able to get health care at this institution or payment for your health care. It will not affect your enrollment in any health plan or benefits you can get. If you choose to take part, you have the right to stop at any time. If there are any new findings during the study that may effect whether you want to continue to take part, you will be told about them as soon as possible. The investigator may decide to discontinue your participation without your permission because he/she may decide that staying in the study will be bad for you, or the sponsor may stop the study. |
|
DRAFT
Offspring Exam 9 – Offsite – PENDING IRB
APPROVAL |
DRAFT RESEARCH CONSENT FORM – PENDING IRB APPROVAL |
OMNI Generation I Exam 4 OMB NO=0925-0216 03-08-2010 |
|
H-24583 - EVALUATION OF THE OMNI GENERATION I COHORT OF THE FRAMINGHAM HEART STUDY |
|
Background |
The Framingham Heart Study is a long term observational research study designed to identify the relationship between risk factors, genetics, cardiovascular disease, and other health conditions over time. In the early 90's, the need to establish a new study reflecting the increasing ethnic/racial diversity of the Framingham community was recognized, and a new group of participants was enrolled. They are the Omni cohort of the Framingham Heart Study. As a member of this group, you are now being asked to take part in a follow-up exam. |
|
|
|
Purpose |
The purpose of this research study is to 1) investigate factors related to the development of heart and blood vessel diseases, lung and blood diseases, stroke, memory loss, cancer, and other diseases and health conditions; and 2) examine DNA and its relationship to the risks of developing these diseases and health conditions. This examination does not take the place of a routine medical check up by your physician |
|
What Happens In This Research Study |
You will be one of approximately
520 subjects to be asked to participate in this study. |
|
Your research examination will take
place at the Framingham Heart Study facility located at 73 Mount
Wayte Avenue in Framingham, MA or other facility/residence. |
|
Risks and Discomforts |
Each of the test procedures and
their risks and discomforts are listed below: |
|
|
|
There may be unknown risks/discomforts involved. Study staff will update you in a timely way on any new information that may affect your health, welfare, or decision to stay in this study. |
|
Potential Benefits |
You will receive no direct benefit from your participation in this study. However, your participation may help the investigators better understand the precursors, etiology, and prevention of cardiovascular disease and other health conditions, including the possibility of genetic linkages. |
|
Alternatives |
Your alternative is to not participate in the study. |
|
Subject Costs and Payments |
You will not be charged for any
part of the examination. If the examination uncovers any medical
problems that require medical diagnosis or treatment, you will be
so advised and that information will be provided to the physician
or clinic that you choose. |
|
Confidentiality |
Any information we obtain about you
during this study will be treated as strictly confidential to the
full extent permitted by applicable law. To ensure
confidentiality, a code number will be assigned to you and any of
your potentially identifying information. |
|
Subject's Rights |
By consenting to participate in
this study you do not waive any of your legal rights. Giving
consent means that you have heard or read the information about
this study and that you agree to participate. You will be given a
copy of this form to keep. If at any time you withdraw from this
study you will not suffer any penalty or lose any benefits to
which you are entitled. |
|
Compensation for Research Related Injury |
If you think that you have been injured by being in this study, please let the investigator know right away. If your part in this study takes place at Boston Medical Center, you can get treatment for the injury at Boston Medical Center. If your part in the study is not at Boston Medical Center, ask the investigator where treatment for injury would be available locally. You and your insurance company will be billed for this treatment. Some research sponsors may offer a program to cover some of the treatment costs which are not covered by your insurance. You should ask the research team if such a program is available. |
|
Right to Refuse or Withdraw |
Taking part in this study is
voluntary. You have the right to refuse to take part in this
study. If you decide to be in the study and then change your mind,
you can withdraw from the research. Your participation is
completely up to you. Your decision will not affect your being
able to get health care at this institution or payment for your
health care. It will not affect your enrollment in any health plan
or benefits you can get. |
|
DRAFT
OMNI Generation I Exam 4 PENDING IRB APPROVAL |
DRAFT RESEARCH CONSENT FORM – PENDING IRB APPROVAL |
OMNI Generation I Exam 4 – Offsite OMB NO=0925-0216 03-08-2010 |
|
H-24583 - EVALUATION OF THE OMNI GENERATION I COHORT OF THE FRAMINGHAM HEART STUDY |
|
Background |
The Framingham Heart Study is a
long term observational research study designed to identify the
relationship between risk factors, genetics, cardiovascular
disease, and other health conditions over time. In the early 90's,
the need to establish a new study reflecting the increasing
ethnic/racial diversity of the Framingham community was
recognized, and a new group of participants was enrolled. They are
the Omni cohort of the Framingham Heart Study. As a member of this
group, you are now being asked to take part in a follow-up exam.
|
|
|
|
Purpose |
The purpose of this research study is to 1) investigate factors related to the development of heart and blood vessel diseases, lung and blood diseases, stroke, memory loss, cancer, and other diseases and health conditions; and 2) examine DNA and its relationship to the risks of developing these diseases and health conditions. This examination does not take the place of a routine medical check up by your physician |
|
What Happens In This Research Study |
You will be one of approximately
520 subjects to be asked to participate in this study. |
|
Your research examination will take
place at the Framingham Heart Study facility located at 73 Mount
Wayte Avenue in Framingham, MA or other facility/residence. |
|
Risks and Discomforts |
Each of the test procedures and
their risks and discomforts are listed below: |
|
|
|
There may be unknown risks/discomforts involved. Study staff will update you in a timely way on any new information that may affect your health, welfare, or decision to stay in this study. |
|
Potential Benefits |
You will receive no direct benefit from your participation in this study. However, your participation may help the investigators better understand the precursors, etiology, and prevention of cardiovascular disease and other health conditions, including the possibility of genetic linkages. |
|
Alternatives |
Your alternative is to not participate in the study. |
|
Subject Costs and Payments |
You will not be charged for any
part of the examination. If the examination uncovers any medical
problems that require medical diagnosis or treatment, you will be
so advised and that information will be provided to the physician
or clinic that you choose. |
|
Confidentiality |
Any information we obtain about you
during this study will be treated as strictly confidential to the
full extent permitted by applicable law. To ensure
confidentiality, a code number will be assigned to you and any of
your potentially identifying information. |
|
Subject's Rights |
By consenting to participate in
this study you do not waive any of your legal rights. Giving
consent means that you have heard or read the information about
this study and that you agree to participate. You will be given a
copy of this form to keep. If at any time you withdraw from this
study you will not suffer any penalty or lose any benefits to
which you are entitled. |
|
Compensation for Research Related Injury |
If you think that you have been injured by being in this study, please let the investigator know right away. If your part in this study takes place at Boston Medical Center, you can get treatment for the injury at Boston Medical Center. If your part in the study is not at Boston Medical Center, ask the investigator where treatment for injury would be available locally. You and your insurance company will be billed for this treatment. Some research sponsors may offer a program to cover some of the treatment costs which are not covered by your insurance. You should ask the research team if such a program is available. |
|
Right to Refuse or Withdraw |
Taking part in this study is
voluntary. You have the right to refuse to take part in this
study. If you decide to be in the study and then change your mind,
you can withdraw from the research. Your participation is
completely up to you. Your decision will not affect your being
able to get health care at this institution or payment for your
health care. It will not affect your enrollment in any health plan
or benefits you can get. |
|
DRAFT
OMNI Generation I Exam 4 – Offsite PENDING IRB APPROVAL |
DRAFT RESEARCH CONSENT FORM OMB NO=0925-0216 03-08-2010 |
Blood Draw Consent for Cell Line Creation |
|
H-22762 - THE FRAMINGHAM HEART STUDY N01-HC-25195 1910G |
|
Background |
A cell line is a frozen sample of specially processed white cells from your blood that allows the Framingham Heart Study to grow more white cells and get more DNA from them in future as needed for research projects. |
|
|
|
Purpose |
A cell line will be created from a blood sample you provide in order to study the cause and prevention of cardiovascular disease and other health conditions, including the possibility of how genetic factors influence health status. |
|
What Happens In This Research Study |
You will be one of approximately
150 subjects to be asked to participate in this study. |
|
Your research blood draw will take
place at the Framingham Heart Study facility located at 73 Mount
Wayte Avenue in Framingham, MA or the place where you reside. |
|
Risks and Discomforts |
Minimal bruising, pain, or bleeding may occur as a result of the blood draw. A latex allergy can occur from the gloves worn by the technician. If you have a known latex allergy, inform the technician and he/she will use another form of protection. |
|
|
|
There may be unknown risks/discomforts involved. Study staff will update you in a timely way on any new information that may affect your health, welfare, or decision to stay in this study |
|
Potential Benefits |
You will receive no direct benefit from your participation in this study. However, your participation may help the investigators better understand the cause and prevention of cardiovascular disease and other health conditions, including the possibility of how genetic factors influence health status. |
|
Alternatives |
Your alternative is to not participate in the study. |
|
Subject Costs and Payments |
You will not be charged for any part of the examination. You will not receive payment for your participation. |
|
Confidentiality |
Any information we obtain about you
during this study will be treated as strictly confidential to the
full extent permitted by applicable law. To ensure
confidentiality, a code number will be assigned to you and your
potentially identifying information. |
|
Subject's Rights |
By consenting to participate in
this study you do not waive any of your legal rights. Giving
consent means that you have heard or read the information about
this study and that you agree to participate. You will be given a
copy of this form to keep. |
|
Compensation for Research Related Injury |
If you think that you have been injured by being in this study, please let the investigator know right away. If your part in this study takes place at Boston Medical Center, you can get treatment for the injury at Boston Medical Center. If your part in the study is not at Boston Medical Center, ask the investigator where treatment for injury would be available locally. You and your insurance company will be billed for this treatment. Some research sponsors may offer a program to cover some of the treatment costs which are not covered by your insurance. You should ask the research team if such a program is available. |
|
Right to Refuse or Withdraw |
Taking part in this study is
voluntary. You have the right to refuse to take part in this
study. If you decide to be in the study and then change your mind,
you can withdraw from the research. Your participation is
completely up to you. Your decision will not affect your being
able to get health care at this institution or payment for your
health care. It will not affect your enrollment in any health plan
or benefits you can get. |
|
DRAFT
Blood Draw Consent for Cell Line Creation |
File Type | application/msword |
File Title | RESEARCH CONSENT FORM |
Author | mpryde |
Last Modified By | curriem |
File Modified | 2010-11-29 |
File Created | 2010-11-29 |