Educating Groups Influencing Generic Drug Use

D E P A R T M EN T O F
Health Outcomes Research
and Policy

Informed Consent: Pharmacists

(NOTE: DO NOT AGREE TO PARTICIPATE UNLESS AN IRB APPROVAL STAMP WITH CURRENT DATES HAS
BEEN APPLIED TO THIS DOCUMENT.)
Informed Consent for a research study entitled: “Educating Groups Influencing Generic Drug Use”
You are invited to participate in a research study to better educate groups influencing generic drug use, based
on their unique educational needs, sponsored by the US Food and Drug Administration (FDA). The study is
being conducted by Dr. Jingjing Qian, Assistant Professor in the Auburn University Department of Health
Outcomes Research and Policy and Dr. Ilene Harris, Principal Research Scientist at IMPAQ International. You
are eligible to participate if you are a pharmacist licensed to practice in the US and are age 19 or older.
As part of your participation in this research study, you will fill out an online survey regarding your review of
the developed educational materials. Your total time commitment will be approximately 20 minutes.
The risks associated with participating in this study are minimal. Your protected health information will not
be used or disclosed to a third party. If you participate in this study, what the research team learns from your
survey may better inform whether the developed educational materials are successful in educating various
groups on generic drugs. You will receive $50 as a token of our appreciation for your participation after
completion of the survey.
If you change your mind about participating, you can withdraw at any time during the study. Your
participation is completely voluntary. If you choose to withdraw, your data can be withdrawn as long as it is
identifiable. Your decision about whether or not to participate or to stop participating will not jeopardize
your future relations with Auburn University, the Department of Health Outcomes Research and Policy, or
IMPAQ International.
If you agree, any data obtained in connection with this study will be anonymous. Notes and completed
surveys from the study will be saved in password protected folders on a password and firewall protected
server at Auburn University.
Information collected through your participation may be published in governmental reports, professional
journals, and/or presented at a professional meeting. As described above, surveys will have no identifying
information attached to them, and if information learned from this study is published, you will not be
identified by name or other personal information. Also, survey answers will be used for analytical purposes
only.
If required, personal information collected in connection to your honorarium will be saved in password
protected folders on a password and firewall protected server at Auburn University. This information is
being collected in order to withhold necessary tax payments on your behalf and will remain private to the
extent permitted by law.
If you have questions about this study, please contact Jingjing Qian at (334) 844-5818 or [email protected]
or Ilene Harris at (443) 259-5250 or [email protected].
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If you have questions about your rights as a research participant, you may contact the Auburn University
Office of Research Compliance or the Institutional Review Board by phone at (334) 844-5966 or e-mail at
[email protected] or [email protected].
HAVING READ THE INFORMATION PROVIDED, YOU MUST DECIDE WHETHER OR NOT YOU WISH TO PARTICIPATE IN
THIS RESEARCH STUDY. IF YOU DECIDE TO PARTICIPATE, PLEASE PRESS ‘YES’ BELOW.

______________________________ ____
Investigator’s Signature
Date
__________________________________
Printed Name
____________________________________
Co-Investigator’s Signature
Date
____________________________________
Printed Name

020 James E. Foy Hall, Auburn, AL 36849-5501; Telephone: 334-844-5152
www.auburn.edu

Page 2 of 2

D E P A R T M EN T O F
Health Outcomes Research
and Policy

Informed Consent: Prescribers

(NOTE: DO NOT AGREE TO PARTICIPATE UNLESS AN IRB APPROVAL STAMP WITH CURRENT DATES HAS
BEEN APPLIED TO THIS DOCUMENT.)
Informed Consent for a research study entitled: “Educating Groups Influencing Generic Drug Use”
You are invited to participate in a research study to better educate groups influencing generic drug use, based
on their unique educational needs, sponsored by the US Food and Drug Administration (FDA). The study is
being conducted by Dr. Jingjing Qian, Assistant Professor in the Auburn University Department of Health
Outcomes Research and Policy and Dr. Ilene Harris, Principal Research Scientist at IMPAQ International. You
are eligible to participate if you are a healthcare provider with US prescriptive authority and are age 19 or
older.
As part of your participation in this research study, you will fill out an online survey regarding your review of
the developed educational materials. Your total time commitment will be approximately 20 minutes.
The risks associated with participating in this study are minimal. Your protected health information will not
be used or disclosed to a third party. If you participate in this study, what the research team learns from your
survey may better inform whether the developed educational materials are successful in educating various
groups on generic drugs. You will receive $50 as a token of our appreciation for your participation after
completion of the survey.
If you change your mind about participating, you can withdraw at any time during the study. Your
participation is completely voluntary. If you choose to withdraw, your data can be withdrawn as long as it is
identifiable. Your decision about whether or not to participate or to stop participating will not jeopardize
your future relations with Auburn University, the Department of Health Outcomes Research and Policy, or
IMPAQ International.
If you agree, any data obtained in connection with this study will be anonymous. Notes and complete surveys
will be saved in password protected folders on a password and firewall protected server at Auburn University.
Information collected through your participation may be published in governmental reports, professional
journals, and/or presented at a professional meeting. As described above, surveys will have no identifying
information attached to them, and if information learned from this study is published, you will not be
identified by name or other personal information. Also, survey answers will be used for analytical purposes
only.
If required, personal information collected in connection to your honorarium will be saved in password
protected folders on a password and firewall protected server at Auburn University. This information is
being collected in order to withhold necessary tax payments on your behalf and will remain private to the
extent permitted by law.
If you have questions about this study, please contact Jingjing Qian at (334) 844-5818 or
[email protected] or Ilene Harris at (443) 259-5250 or [email protected].

Page 1 of 2

If you have questions about your rights as a research participant, you may contact the Auburn University
Office of Research Compliance or the Institutional Review Board by phone at (334) 844-5966 or e-mail at
[email protected] or [email protected].
HAVING READ THE INFORMATION PROVIDED, YOU MUST DECIDE WHETHER OR NOT YOU WISH TO PARTICIPATE
IN THIS RESEARCH STUDY. IF YOU DECIDE TO PARTICIPATE, PLEASE PRESS ‘YES’ BELOW.

______________________________ ______
Investigator’s Signature
Date
____________________________________
Printed Name
____________________________________
Co-Investigator’s Signature
Date
____________________________________
Printed Name

020 James E. Foy Hall, Auburn, AL 36849-5501; Telephone: 334-844-5152
www.auburn.edu

Page 2 of 2

D E P A R T M EN T O F
Health Outcomes Research
and Policy

Informed Consent: Patients/Caregivers

(NOTE: DO NOT SIGN THIS DOCUMENT UNLESS AN IRB APPROVAL STAMP WITH CURRENT DATES HAS BEEN
APPLIED TO THIS DOCUMENT.)
Informed Consent for a research study entitled: “Educating Groups Influencing Generic Drug Use”
You are invited to participate in a research study to better educate groups influencing generic drug use, based
on their unique educational needs, sponsored by the US Food and Drug Administration (FDA). The study is
being conducted by Dr. Jingjing Qian, Assistant Professor in the Auburn University Department of Health
Outcomes Research and Policy and Dr. Ilene Harris, Principal Research Scientist at IMPAQ International. You
were selected as a possible participant because you have been identified as a patient or caregiver and are age
19 or older.
As part of your participation in this research study, you will speak to one of our team’s researchers in person
on the Auburn University main campus (zip 36849) to answer a survey about your review of the developed
educational materials. Your total time commitment will be approximately 30 minutes.
The risks associated with participating in this study are minimal. Your protected health information will not
be used or disclosed to a third party. If you participate in this study, what the research team learns from your
survey may better inform whether the developed educational materials are successful in educating various
groups on generic drugs. You will receive $25 as a token of our appreciation for your participation after
completion of the survey.
If you change your mind about participating, you can withdraw at any time during the study. Your
participation is completely voluntary. If you choose to withdraw, your data can be withdrawn as long as it is
identifiable. Your decision about whether or not to participate or to stop participating will not jeopardize
your future relations with Auburn University, the Department of Health Outcomes Research and Policy, or
IMPAQ International.
If you agree, any data obtained in connection with this study will be anonymous. Notes and completed
surveys will be saved in password protected folders on a password and firewall protected server at Auburn
University.
Information collected through your participation may be published in governmental reports, professional
journals, and/or presented at a professional meeting. As described above, surveys will have no identifying
information attached to them, and if information learned from this study is published, you will not be
identified by name or other personal information. Also, survey answers will be used for analytical purposes
only.
Participant’s Initials _____

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If required, personal information collected in connection to your honorarium will be saved in password
protected folders on a password and firewall protected server at Auburn University. This information is
being collected in order to withhold necessary tax payments on your behalf and will remain private to the
extent permitted by law.
If you have questions about this study, please ask them now or contact Jingjing Qian at (334) 844-5818
or [email protected] or Ilene Harris at (443) 259-5250 or [email protected].
If you have questions about your rights as a research participant, you may contact the Auburn
University Office of Research Compliance or the Institutional Review Board by phone at (334) 844-5966
or e-mail at [email protected] or [email protected].
HAVING READ THE INFORMATION PROVIDED, YOU MUST DECIDE WHETHER OR NOT YOU WISH TO PARTICIPATE IN
THIS RESEARCH STUDY. IF YOU DECIDE TO PARTICIPATE, YOUR SIGNATURE WILL SERVE AS YOUR AGREEMENT TO
DO SO. A COPY OF THIS LETTER IS YOURS TO KEEP.

______________________________ ______
Participant’s Signature
Date
____________________________________
Printed Name

______________________________ ______
Investigator’s Signature
Date
____________________________________
Printed Name
____________________________________
Co-Investigator’s Signature
Date
____________________________________
Printed Name

020 James E. Foy Hall, Auburn, AL 36849-5501; Telephone: 334-844-5152
www.auburn.edu

Page 2 of 2