improving nutritional intake of hospital patients using a ... · improving nutritional intake of...
TRANSCRIPT
Improving nutritional intake of hospital patientsusing a persuasive tablet application
Master’s thesis
Sjoerd Smink
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Informeret samtykke til deltagelse i et biomedicinsk forskningsprojekt.
Forskningsprojektets titel: iPad Kostregistrering- udviklingsprojekt
Erklæring fra forsøgspersonen: Jeg har fået skriftlig og mundtlig information og jeg ved nok om formål, metode, fordele og ulemper til at sige ja til at deltage.
Jeg ved, at det er frivilligt at deltage, og at jeg altid kan trække mit samtykke tilbage uden at miste mine nuværende eller fremtidige rettigheder til behandling.
Jeg giver samtykke til, at deltage i forskningsprojektet. Jeg har fået en kopi af den skriftlige information om projektet til eget brug.
Forsøgspersonens navn: ____________________________________________________
Dato: _______________ Underskrift:
Ønsker du at blive informeret om forskningsprojektets resultat (på engelsk)?:
Ja _____ (sæt x) Nej _____ (sæt x)
Erklæring fra den forsøgsansvarlige:
Jeg erklærer, at forsøgspersonen har modtaget mundtlig og skriftlig information om forsøget.
Efter min overbevisning er der givet tilstrækkelig information til, at der kan træffes beslutning om deltagelse i forsøget.
Den forsøgsansvarliges navn: Sjoerd Smink
Dato: _______________ Underskrift:
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