Oral Script to obtain assent from Children 5-6 (in the N

Approval Date: March 19, 2015
Approved Consent Version No.: 1
PI Name: Derek Cummings
IRB No. 00005474

P.I. Derek Cummings
IRB #5474

Version 12, March 16, 2015

Oral Script to Obtain Assent from
Children 5-6 (In the nurse’s office)
Hi, my name is [interviewer’s name]. I am doing a study of the flu with the
University of Pittsburgh and Johns Hopkins University. Flu and other germs
make people sick. We would like to take a swab of your nose to find out if you
have the flu or are sick with another virus. I am also going to ask you a few
questions about how you feel now. If you don’t want to do this, you can say no
at anytime. No one will be mad at you. If you don’t want to answer any of the
questions you don’t have to.
The swab that we take from your nose may hurt.
information that we collect from you private.

We will keep all the

Do you have any questions?
Do you agree to take part in the study?

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