[MCH Jurisdictional Survey
Eligibility and Consent Scripts]
[Ñan an Maroñ Bōk Koṇaan
AK “Eligible”]
Yokwe, eta in __________________. In jabokan juon iien etale eo im ej ñan an ḷapḷọk ad meḷeḷe kōn kiltōn ājmuur eo ilo kōrā ro im ajri ro ilo Aelōñ Kein. Aṃ bōk koṇaaṃ ilo jerbal in allo in enaaj kūtbuuj aṃ naaj uwaak jet laajrak in kajjitōk ko kōn ājmuur eo ilo kwe im ajri ro nejiṃ.
[Ñe ruuwaak eo Kōrā, etal ñan juon. Ñe ruuwaak Eṃṃaan, ak ejjab alikkar, etal ñan kajjitōk 4]
Kar ekkāālel tak wōt em im jujen wōt po ṃweo ṃōm. Imaroñ ke kajjitōk ippaṃ jet kajjitōk ñan aō lale ñe kwōj maroñ pād ilo jerbal in allo in?
Aaet [Etal ñan 2]
Jaab [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Iiō eo aṃ ej ke 18 iiō lōñḷọk?
Aaet [Etal ñan 3]
Jaab [Etal ñan 4]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Kwōj ke jinen ak juon kōrā eo im ej bōk eddoon/ri-lale ajri eo im ej 0 ñan 17 iiō dettan im ej jokwe ilo ṃweo ṃōm.
Aaet [Etal ñan kōmālim ilo an meḷeḷe]
Jaab [Etal ñan 4]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Ewōr ke kōrā ilo ṃweo iṃōm im ej 18 iiō ak dittoḷọk eo im ej jinen ak ej bōk eddoon/ri-lale juon ajri eo im ej 0 ñan 17 an iiō im imaroñ naaj kōnnaan ippān?
Aaet [Etal ñan jinoin]
Aaet ak ejako ak ejjab maroñ itok kiiō [Etal ñan 5]
Jaab [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Ebar wōr ke juon iien eṃṃanḷọk ñan ad rooltok in kōnnaan ippān?
Aaet [Jeik raan im iien eo]
Jaab [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Kōmālim
[INFORMED CONSENT OBTAINED AFTER DETERMINING ELIGIBLE CHILD(REN) IN THE HOUSEHOLD]
[KAR BŌK PEBA IN KŌMĀLIM ILO AN MEḶEḶE EO ĀLIKIN AN JEḶĀ KŌN AJRI EO/RO ILO ṂWEO IM REJ “ELIGIBLE” ILO ṂŌN JOKWE EO]
Āinwōt aō kar ba, kōṃij kōṃṃane jōrpe in ilo [American Samoa/Federated States of Micronesia/Marshall Islands/Northern Mariana Islands/Palau] ñan lapḷọk ad meḷeḷe kōn ājmuur eo ilo kōrā ro im ajri ro nejier. Jōrpe in ej jabokan “Title V MCH Block Grant” būrookraaṃ eo im jāān ko an rej itok jān “Health Resources and Services Administration (HRSA)” eo.
Uwaak ko aṃ renaaj kōṃṃan bwe būrookraaṃ ko ilo ijoko jikūmi ren maroñ lapḷọk aer meḷeḷe kōn kiltōn ājmuur ilo kōrā im ajri ro im naaj kōjerbal meḷeḷe kein ñan jipañ ejaak im leḷọk jerbal in jipañ baaṃle ko. Jōrpe in emaroñ bōk joñan ṇe 50 minit im kajjitōk kein renaaj kōn ājmuur eo ilo kwe im ajri eo nejūm.
Komaroñ jab bōk koṇaaṃ ilo jerbal in allo. Komaroñ kāālōt bwe kwōn bōk koṇaaṃ ilo jerbal in allo in innām ukōt aṃ ḷōmṇak tokālik. Komaroñ jab uwaaki kajjitōk ko kwōjjab kōnnaan uwaaki.
Jet kajjitōk remaroñ kaabṇōṇōik aṃ ḷōmṇak ak bōklōkōt, bōtaab ijellọkwin menin ekkōl kein ikijjeen ḷōmṇak ak bōklōkōt eo aṃ, ejjeḷọk bar menin uwōta ko jeḷā kaki im renaaj jelōt kwe im baaṃle eo aṃ ñe kwōnaaj kāālōt bwe kwōn bōk koṇaaṃ.
Eḷaññe kwōnaaj kāālōt bwe kwōn bōk koṇaaṃ, enaaj iwōj juon men dikdik ñan kaṃṃoolol eok, bōtaab ejjeḷọk menin jipañ en enaaj kajju waj ñan eok jān aṃ kar uwaake kajjitōk ko ilo jōrpe eo.
Naaj dāpij wōt im jab kadiwōjḷọk meḷeḷe ko aṃ. Armej ro im renaaj maroñ lo uwaak ko aṃ ej ro im renaaj kajjeikik jerbal kein im armej ro im rej tōl jerbal in allo in im renaaj lale bwe en jiṃwe ad kajjeikik jerbal in allo eo. Jeban likit etaṃ ilo jōrpe eo ippān uwaak ko aṃ. Jenaaj kōjerbal laajrak in nōṃba ko ñan ad jeḷā meḷeḷe ko rej etal iaḷḷọk, im jab etaṃ.
Jōrpe in etale eo ejjab kajjitōk ñe ej nana an juon lale ajri ak ñe ewōr ej kōjool ajri. Ñe jenaaj jeḷā ke ilo ṃōn jokwe, ewōr jorāān ej waḷọk ilo tōre eṇ eṃ jōrpe eṇ ej bōk jikin ñan juon ajri ak ke ewōr ej kōjool juon ajri ilo iien jerbale jōrpe en, jenaaj aikuj ripooti ñan ro tōllọkier.
Jouj im kepaak X ilo (XXX) XXX-XXXX ak XXXXX kōn kajjitōk, abṇōṇō, ak inepata ikijjeen jerbalin allo/etale/ekkatak. Ñe ewōr am kajjitōk am abṇōṇō ikijjeen jiṃwe ko aṃ āinwōt juon eo ear bōk koṇaan ilo jerbal in allo (research), jouj im kepaak NORC Institutional Review Board Mānija eo ilo talboon nōṃba in: (866) 309-0542.
Ij likit wōt peba in ippaṃ bwe en wōr aṃ rekoot kōn men ko ejkab ṃōj ao ba. [Leḷọk juon arin peba in kōmmeḷeḷe in kōmālim ilo an meḷeḷe]
Ewōr ke aṃ kajjitōk?
Aaet [Uwaaki kajjitōk ko, innām etal ñan B]
Jaab [Etal ñan B]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Kwōj ke errā in uwaaki kajjitōk ko ilo jōrpe eo?
Aaet [Kaṃṃoolol armej eo innām jino jōrpe eo]
Jaab [Kaṃṃoolol armej eo kōn iien ko an innām etal]
Eṃakoko in Uwaak [Kaṃṃoolol armej eo kōn iien ko an innām etal]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Marshallese Translation by Jimmie Akeang |
| File Modified | 0000-00-00 |
| File Created | 2021-04-06 |