Consent Note Templates

What this page tells you

Copy-paste consent note templates for REDCap for each protocol: 3T LEN (819126), 7T (818407), Collaborative (821778, with Behnke-Fried electrode wording), Pioneer (849276) and MXene (856681). Fill in date, ICF version, who was present and your name.

eConsent Notes: to be added to REDCap
3T LEN (819126):
This participant was consented to the Davis 3T LEN protocol #819126 on (DATE) in HUP6 FNDBAMR2. ICF version: (VERSION NUMBER). The consent was reviewed with the participant and their questions about how the data would be used for research were answered. Participant understood the research and was open to participating, and was aware they could decline to participate at any point. Then the participant signed the consent form and was given a copy. They are aware of the phone number to contact if they have any questions. NAMES OF WHO WAS PRESENT. SIGNED: YOUR NAME

7T (818407):
This participant was consented to the Davis 7T protocol #818407 on (DATE) in Stellar Chance. ICF version: (VERSION NUMBER) The consent was reviewed with the participant about how the data would be used for research were answered. Participant understood the research and was open to participating, and was aware they could decline to participate at any point. Then the participant signed the consent form and was given a copy. They are aware of the phone number to contact if they have any questions. NAMES OF WHO WAS PRESENT. SIGNED: YOUR NAME

Collaborative Consent (821778):
Date of consent (DATE), (PLACE OF CONSENT). The ICF was provided to the subject for review; protocol #821778; ICF version (NUMBER). The participant was given adequate time to read the informed consent, was given the opportunity to ask questions and their questions were answered prior to signing consent. (NAMES) were present for consent. Discussion of purpose of trial, risks/benefits of participation, procedures, schedule of events, costs (if any). Participation is voluntary. If patient agrees to research electrodes, add the following: Placement of Behnke-Fried Electrode was discussed by Dr. Chen (lead surgeon) and research coordinator. Patient agreed to placement of electrode. Participant verbalized understanding by signing the consent. Copy of consent was provided to the participant. No study-related procedures were performed prior to signing the consent for participation. Signed: YOUR NAME

Pioneer (849276):
This participant was consented to the Pioneer protocol 849276 on (DATE) in the epilepsy monitoring unit (EMU). ICF version: (VERSION NUMBER). The consent was reviewed with the participant and their questions about how the data would be used for research were answered. Participant understood the research and was open to participating, and was aware they could decline to participate at any point. Then the participant signed the consent form and was given a copy. They are aware of the phone number to contact if they have any questions. NAMES OF WHO WAS PRESENT. SIGNED: YOUR NAME

Mxene (856681):
This participant was consented to the Validating MXene Electrodes for Next Generation EEG protocol #856681 on (DATE) in PAV10. ICF version: (VERSION NUMBER). The consent was reviewed with the participant, and their questions about how the data would be used for research were answered. Participant understood the research and was open to participating, and was aware they could decline to participate at any point. Then the participant signed the consent form and was given a copy. They are aware of the phone number to contact if they have any questions. NAMES OF WHO WAS PRESENT. SIGNED: YOUR NAME