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INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY

Challenge/Study Title	Question Challenge
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	$20
Included Products & Services	Online Platform Access, Study Materials
Outcome Measures	PHQ-8, Personalized Feedback
Contact	help@efforia.com

Hey there! You're being invited to join a research study titled "Question Challenge" hosted on Efforia. This document will guide you through what it means to be a participant. Make sure you understand everything and feel comfortable before moving forward. If you have any uncertainties or questions, please don’t hesitate to reach out to us at help@efforia.com before you decide to participate.

The Purpose of This Study

This study is designed to explore how answering specific questions can affect self-perception and mental health. By participating, you'll help us understand more about cognitive processes and emotional well-being. The feedback you provide will contribute to improvements in question-based therapeutic techniques. Ultimately, we aim to enhance self-awareness and mental health support through innovative questioning methods.

Your Responsibilities as a Participant

As a participant, you're expected to engage actively and honestly with the study materials. You should commit to answering all questions to the best of your ability and complete any assigned tasks. Participants should be open to self-reflection and willing to provide genuine feedback. Your involvement will be crucial to the success of this study and will contribute to broader understanding in this field.

Your Rights as a Participant

Remember, your participation in this study is entirely voluntary, and you can decide to withdraw at any time. Unfortunately, refunds are not available if you choose to leave the study, as your initial payment contributes to maintaining the quality and integrity of the study for all participants.

How to Leave the Study

To leave the study, simply go to your Profile page, click on “Your Challenges,” and select “leave.” Please remember your join fee is not refundable. This payment is crucial to ensure a consistent and effective study environment for remaining participants.

Risks and Benefits

Participating in this study may make you face some uncomfortable questions which could evoke emotional responses. It's important to consider your own mental health when deciding to participate. While the study does not provide medical diagnosis or treatment, it could offer personal insights through assessments. Benefits include contributing to a better understanding of cognitive and emotional responses. Always consult with a medical professional or life coach if you have concerns. In case of feeling suicidal, please contact the National Suicide Prevention Hotline by dialing 988.

What to do if you have an adverse event or medical emergency

If you experience any medical emergencies or adverse events during the study, please seek immediate care from local medical professionals. After you've received appropriate care, report the incident to us at help@efforia.com for our records and further assistance.

Data Protections

Your data will be collected to assess the effectiveness of our study and to provide you with personalized feedback and reminders. Rest assured, only authorized personnel can access your data, and it's stored on secure servers. While participating, you're encouraged to share your experiences using Efforia’s community features, yet you can adjust your privacy settings according to your comfort level. Please review our Terms & Conditions and Privacy Policy for more detailed information.

If you have questions

If you have any questions about the study, feel free to engage with the community or contact us directly at help@efforia.com. We're here to help and want to make sure you feel supported throughout your journey in this study.

California Experiential Research Subject’s Bill of Rights

As a participant in California, you are entitled to certain rights under the California Experiential Research Subject’s Bill of Rights, which ensures your freedom to inquire, decide, and participate voluntarily in research studies without coercion, and provides you with the right to receive answers to any questions regarding the study procedures.

HIPAA Waiver

By joining this study, you agree to waive certain privacy protections afforded by the HIPAA Privacy Rule, allowing the necessary sharing of your health information as part of the study. This enables researchers to analyze data effectively while still committing to confidentiality and security measures outlined in our privacy policy. ```

1. Authorization and Consent for Diagnostic Testing

1. 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:
   1. 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.
   2. 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.
   3. 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.
   4. 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.
   5. My health information and results may be shared with CWI employees and agents for the purpose of ordering, processing, and reporting my results.
   6. 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.
   7. I authorize CWI to contact me via text message to communicate with me regarding my test.

1. Patient Rights and Privacy Practices
   1. 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.
   2. 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.

1. Release
   1. 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.
   2. 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.