Att F - IHC FocusGroupConsent

A ttachment F

Informed Consent Information for IHC Focus Group

The College of American Pathologists (CAP) and the Centers for Disease Control and Prevention (CDC) thank you for agreeing to participate in a focus group on the topic of immunohistochemistry (IHC) validation practices in conjunction with our initiative: “Improving the Impact of Laboratory Practice Guidelines: A New Paradigm for Metrics."

• Your participation is completely voluntary. Your individual or laboratory information will not be identified in any publications or shared with the CAP or the CDC beyond the cooperative agreement project members present in the room.

• The lead moderator and the CAP staff will be taking notes during the discussion; however, we will not be recording by any video or audio mechanism. Any written reports of information will be aggregated and specific comments will not be identified.

• Questions are open-ended and can be answered with positive, negative, or neutral responses. There are no penalties or repercussions. You may discontinue participation at any time either by not answering a question or leaving the session.

• The focus group session will occur on Wednesday, September 14, 2016, last no more than 60 minutes and a light meal will be served.

  • The laboratory professionals’ peer discussion group will begin at 7:00 AM with check-in available at 6:45 AM

  • The pathologists’ peer discussion group will begin at Noon with check-in available at 11:45 AM.

• We will maintain a copy of this consent form for the duration of the cooperative agreement (until August 2018). Please keep a copy for your records.

I have read and understand the above information and agree to participate.

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Print name

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Signature Date

Return completed consent form by Monday, September 12, 2016.

Email: [email protected] | Fax: 847-832-8209

Any questions before or after your participation may be addressed to Lisa Fatheree at the contact information below.

Lisa A. Fatheree Director, Pathology and Laboratory Quality Center t: 800-323-4040 ext. 7209

f: 847-832-8209 [email protected]

325 Waukegan Rd. Northfield, IL 60093 800-323-4040 | cap.org