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.
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| INFORMED CONSENT DOCUMENT AGREEMENT TO BE IN A RESEARCH STUDY | |
|---|---|
| Challenge/Study Title | Time of day test (24 Hour Trip to Paris) |
| 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 | Online Community Access, Digital Research Tools |
| Outcome Measures | Well-being and Productivity Metrics |
| Contact | help@efforia.com |
The Purpose of This Study
Our goal is to determine how different times of the day impact your productivity and overall well-being. By simulating a 24-hour trip to Paris, we hope to gain insights into optimal activity scheduling. We also aim to further our understanding of circadian rhythms. Your participation will contribute valuable data to this field of study.Your Responsibilities as a Participant
We're seeking individuals who are open-minded, diligent, and punctual. As a participant, you'll be required to follow the simulated schedule and report your feelings and productivity levels at different times. Your honesty and accuracy in reporting are crucial to the success of this study. Above all, we ask that you commit to the full duration of the study.Your Rights as a Participant
Remember, your participation is completely voluntary! You can choose to leave the study at any time. Please note, however, that refunds are not available once you've joined. After all, your join fee is what makes this study possible.How to Leave the Study
Feeling like it's not for you? No worries! You can leave the study anytime by going to your Profile page, click on "Your Challenges", and then click "leave". Please note, your join fee is not refundable. This is to ensure we can continue providing a valuable study experience for other participants.Risks and Benefits
As with any study, there are risks and benefits. You might experience some discomfort or fatigue as you adjust to the simulated schedule. If at any point you feel overwhelmed, please seek immediate help. If you're feeling suicidal, you can contact the National Suicide Prevention Hotline by dialing 988. On the flip side, you'll gain insights into your own productivity patterns and contribute to a growing body of knowledge. As always, please consult a medical professional if you have any doubts or concerns about participating.What to do if you have an adverse event or medical emergency
If you experience any adverse event or medical emergency, please seek immediate medical attention. Once you've sought care, you can report the incident to us at help@efforia.com.Data Protections
Rest assured, your data is safe with us. We'll be collecting data on your reported feelings and productivity levels, but only those you've approved will have access to it. We'll use this data to send you tailored reminders and personalized outcome reports. And remember, you can adjust your communication preferences anytime in your Profile settings. Be sure to review our Terms & Conditions and Privacy Policy for more information.If you have questions
Got questions? That's what the Efforia community is here for! If you prefer one-on-one help, feel free to reach out to us at help@efforia.com.California Experiential Research Subject’s Bill of Rights
As a participant in this study, you have certain rights. These include the right to be informed of the nature and purpose of the experiment, the right to decline participation at any time, the right to confidentiality, and the right to be informed of any new findings that might affect your willingness to participate.HIPAA Waiver
This study involves the collection, use, and sharing of your health information. By participating, you are waiving your rights under the Health Insurance Portability and Accountability Act (HIPAA) to keep this information private. Your information will be used for research purposes only and will be kept confidential to the extent permitted by law. ```- Authorization and Consent for Diagnostic Testing
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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.
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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.
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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.