What You Need to Know to Participate
This document provides information to help you decide whether to join this research study. It is important you understand the responsibilities, risks and benefits of participating.
INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY
| Challenge/Study Title | Override Rule ttesting |
|---|---|
| Challenge Coach (The Person in Charge of This Research Study) | Efforia Advanced Author |
| Sponsor | This study is made possible by your payment to join. |
| Challenge Cost | $0 |
| Included Products & Services | None |
| Outcome Measures | Based on your participation and feedback |
| Contact | help@efforia.com |
The Purpose of This Study
This study aims to test the effectiveness of the Override Rule in certain scenarios. We're seeking to understand its impact on decision-making processes, its potential benefits, and possible drawbacks. Your participation will contribute to a better understanding of this rule and its applications. We hope to use this knowledge to improve the experience for everyone on Efforia.Your Responsibilities as a Participant
We're looking for explorers who are open, curious, and adaptable. Your task? Engage with the Override Rule, share your experiences, and give us your honest feedback. Your unique perspective is our compass in this research journey. Remember, your involvement is crucial to the success of this study.Your Rights as a Participant
Your participation is 100% voluntary and you can jump ship at any time. However, we won't be able to refund your join fee. This fee helps maintain the integrity of the study for other participants.How to Leave the Study
If you decide to leave, head over to your Profile page, click on “Your Challenges”, and then click “leave”. Please note, your join fee is not refundable. This fee ensures the study remains a valuable experience for all participants.Risks and Benefits
Every journey has its risks and rewards. Participating in the study might lead you to encounter uncomfortable questions, which could cause emotional discomfort. If you ever feel overwhelmed, remember, there are experts standing by to assist you. If you're feeling suicidal, contact the National Suicide Prevention Hotline by dialing 988. As with any adventure, it's crucial to prepare. Consult with a medical professional before joining this study. Remember, your insurance may not cover research-related injuries. This study does not promise any medical diagnosis or cure, but you will gain new insights and knowledge through assessments and test results.What to do if you have an adverse event or medical emergency
If you find yourself in a medical emergency, seek immediate help from your local medical care provider. Once you're safe, please report any adverse events to help@efforia.com.Data Protections
Your data is your treasure and we guard it fiercely. We will only collect data relevant to the study and it will only be accessed by those you have specifically approved. Your data will help us send you personalized reminders, outcome reports, and overall findings. All your data is stored in our secure servers. We encourage you to adjust your communication preferences to your comfort level. Please review the Efforia Terms & Conditions and Privacy Policy for more information.If you have questions
If you're feeling lost or confused, reach out to the community, that’s what it’s here for! If you prefer a more private conversation, email us at help@efforia.com.California Experiential Research Subject’s Bill of Rights
As a participant in this study, you have rights! You have the right to be treated with respect, to withdraw at any time, to have your privacy protected, to be informed about the study's results, and to have any of your questions answered.HIPAA Waiver
By participating in this study, you agree to waive certain protections under the Health Insurance Portability and Accountability Act (HIPAA). This waiver allows us to collect, use, and disclose your health information for this specific research study. Your health information will be protected in accordance with our privacy policy and data protection procedures.- Authorization and Consent for Diagnostic Testing
-
I voluntarily consent and authorize CWI Physician Partners P.C., a California professional corporation; CWI Physician Partners P.C., a Hawaii professional corporation; CWI Physician Partners P.C., a Georgia professional corporation; CWI Physician Partners P.C., a Kansas professional corporation; CWI Physician Partners P.C., an Oregon professional corporation; CWI Physician Partners P.C., a Nevada professional corporation, CWI Physician Partners P.C., a Rhode Island professional corporation; CWI Physician Partners P.C., an Oklahoma professional corporation, as applicable ("CWI") to review the collection, testing, and analysis for the purposes of a diagnostic screening test. I understand that there are risks and benefits associated with undergoing a diagnostic screening testing and there may be a potential for false positive or false negative test results. I assume complete and full responsibility to take appropriate action with regards to my test results. Should I have questions or concerns regarding my results, or a worsening of my condition, I shall promptly seek advice and treatment from an appropriate medical provider. I further acknowledge the following:
- I am the individual who will provide the sample for the Test(s) that I am requesting or I am the parent or legal guardian of a minor who is providing the sample for testing.
- I am at least eighteen (18) years of age or I am the parent or legal guardian of a minor who is providing the sample for testing.
- I have read and understand the information provided about the Test(s) that I have been provided on the website where I requested the Test.
- The information I have provided in connection with my request to CWI is correct to the best of my knowledge. I will not hold CWI or its employees or agents responsible for any errors or omissions that I may have made in providing such information.
- My health information and results may be shared with CWI employees and agents for the purpose of ordering, processing, and reporting my results.
- Medical Services provided by CWI are purely for diagnostic assistance purposes and do not create a physician-patient relationship, and do not constitute medical care or diagnosis or treatment of any condition, disease, or illness.
- I authorize CWI to contact me via text message to communicate with me regarding my test.
-
Patient Rights and Privacy Practices
- Notice of Privacy Practices and Patient Rights: CWI Notice of Privacy Practices describes how it may use and disclose your protected health information for other purposes that are permitted or required by law. To review a copy of CWI Notice of Privacy Practices, go to http://www.CynergyWellness.com.
- Disclosure to Government Authorities: I acknowledge and agree that my test results and associated information may be disclosed to appropriate county, state, federal, or other governmental and regulatory entities as may be permitted by law.
-
Release
- To the fullest extent permitted by law, I hereby release, discharge and hold harmless, CWI, including, without limitation, any its respective officers, directors, employees, representatives and agents from any and all claims, liability, and damages, of whatever kind or nature, arising out of or in connection with any act or omission relating to my diagnostic test or the disclosure of my test results.
- By selecting the ACKNOWLEDGEMENT during the registration process for diagnostic testing, I acknowledge and agree that I have read, understand, and agreed to the statements contained within this form. I have read the contents of this form in its entirety and voluntarily consent to proceed with these procedures.