TITLE OF RESEARCH: Health Information and Health Care Services Survey for Individuals with Disabilities
INVESTIGATORS: Dr. Brian F. Geiger, Dr. Marcia R. O’Neal, Dr. Retta Evans, Dr. Betty Nelson & Mr. Stephen Firsing III
SPONSOR: Alabama Council for Developmental Disabilities
Explanation of Procedures: You are invited to complete a survey to discuss health information and health care services available to individuals with disabilities. The information you provide will be used by United Cerebral Palsy of Greater Birmingham and researchers at the University of Alabama at Birmingham to develop training modules for consumers and health care professionals.
The survey will take about 15 minutes. Read this form before deciding whether to participate. There is no obligation to complete any or all of the information on this form. Your personal identity will not be revealed to others.
Risks and Discomforts: Risks are not greater than those encountered during daily life. If there are any specific questions you do not wish to answer, please skip them and move on to the next question.
Benefits: You may not personally benefit from your participation in this research; however, your participation will be helpful to develop training and advocacy materials for individuals with disabilities.
Alternatives: You may decline participation at no penalty.
Confidentiality: All information provided will remain confidential to the extent of the law. The UAB Institutional Review Board (IRB) and the sponsor, the Alabama Council for Developmental Disabilities, may review the research records for auditing purposes.
Withdrawal Without Prejudice: You are free to withdraw your consent and to discontinue participation in this survey at any time.
Cost of Participation: There will be no cost to you to participate in the research.
Payment for Participation in Research: There is no payment for participation in this survey.
Questions: Call Dr. Brian Geiger at 205-975-5388 if you have any questions about the research. If you have questions about your rights as a research participant, contact Ms. Sheila Moore, Director of the UAB Office of the Institutional Review Board for Human Use (IRB). Ms. Moore may be reached between the hours of 8:00 a.m. and 5:00 p.m. CT, Monday through Friday, at (205) 934-3789 or 1-800-822-8816. Press the option for an operator/attendant and ask for extension 4-3789.
Legal Rights: You are not waiving any of your legal rights by signing this consent form.