Oral Script to obtain assent from Children 13 plus (in t

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 13 (In nurse office)
Hi, my name is [interviewer’s name]. I am doing a study of the acute respiratory
illness with the University of Pittsburgh and Johns Hopkins University. Flu and
other viruses 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. It will take about 5 minutes. If
you don’t want to do this, you can say no at anytime. No one will be angry with
you if you do not want to participate. 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. We will keep all the
information that we collect from you confidential. Your name will not be on the
sample that we collect. We will not share the answers to the questions we ask
you or the results of the tests will run on your swab with anyone.
Do you have any questions?
Do you agree to take part in the study?

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