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 | Re-Schedule Testing |
| 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 | $110 |
| Included Products & Services | Oura Ring |
| Outcome Measures | PHQ-8 |
| Contact | help@efforia.com |
The Purpose of This Study
This study aims to evaluate the impact of re-scheduling minor daily activities on your overall mental health. We will investigate how changes in routine can affect your mood, energy levels, and overall satisfaction in life. This research will help us understand better ways to improve mental health. Your participation will provide valuable insights into this area.Your Responsibilities as a Participant
We're looking for participants who are open to shaking up their daily routines and are comfortable with wearing the Oura Ring product. You'll be asked to make minor changes to your schedule and provide feedback on how these changes affect your mood and energy levels. You'll also need to be comfortable with answering questions about your emotional state. Please remember, honesty is the best policy here!Your Rights as a Participant
Participation in this study is completely voluntary. You have the right to leave the study at any time without any negative consequences. However, please note that the join fee is non-refundable. This is to ensure the integrity of the study and fairness to all participants.How to Leave the Study
If you decide to leave the study, simply go to your Profile page, click “Your Challenges” and click “leave.” Please remember your join fee is not refundable. This payment is important to keep the study experience sound for other participants.Risks and Benefits
Participating in this study may cause some discomfort as you adjust to changes in your routine. It may also bring up negative emotions or stress. However, it's important to remember that this study is designed to find ways to improve mental health, and any discomfort should be temporary. If at any point you feel overwhelmed, we encourage you to seek help from a mental health professional or contact the National Suicide Prevention Hotline at 988. Please consult with a medical professional if you have any doubts about participating in this study. This study is not intended to diagnose or cure any condition and may not provide any direct benefit to you, other than the knowledge you gain from participating.What to do if you have an adverse event or medical emergency
If you experience any adverse events or medical emergencies, please seek immediate medical attention. Once you're safe, please report any incidents to help@efforia.com. We're here to support you, but your safety comes first.Data Protections
We'll be collecting data on your daily activities and mental state. This data will only be accessed by the research team and will be used to send you reminders, personalized reports, and overall study findings. All your information is stored on secure servers. However, as this is a community study, we encourage you to share your experiences with others. Please review your communication preferences to ensure you're comfortable with how your data is used. Don't forget to check out the Efforia Terms & Conditions and Privacy Policy.If you have questions
If you have any questions, feel free to ask the community. If you'd rather ask your question privately, please email help@efforia.com.California Experiential Research Subject’s Bill of Rights
As a participant in this study, you have several rights under the California Experiential Research Subject’s Bill of Rights. These include the right to be informed about the study, to refuse to participate, to leave the study at any time, and to be provided with answers to any questions you may have about the study.HIPAA Waiver
By participating in this study, you are waiving your rights under the Health Insurance Portability and Accountability Act (HIPAA). This means that we may collect, use, and disclose your health information for this study. However, we will take all necessary steps to protect your privacy and the confidentiality of your information.- 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.