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Consent Form

This document contains an informed consent form for individuals participating in a study using an alcohol saliva analyzer. The form outlines that alcohol is a controlled substance that can impact cognition and health. It then invites participants to volunteer for a study using a saliva analyzer to detect alcohol concentration. The summary provides details on the student researchers, the voluntary and confidential nature of the study, and requirements for participants to be 18+ years old and residents of a particular area.

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MAXINE RUIDERA
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98 views2 pages

Consent Form

This document contains an informed consent form for individuals participating in a study using an alcohol saliva analyzer. The form outlines that alcohol is a controlled substance that can impact cognition and health. It then invites participants to volunteer for a study using a saliva analyzer to detect alcohol concentration. The summary provides details on the student researchers, the voluntary and confidential nature of the study, and requirements for participants to be 18+ years old and residents of a particular area.

Uploaded by

MAXINE RUIDERA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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This informed consent form is for individuals who will be using the alcohol saliva analyzer in order for

them to be aware of their saliva alcohol concentration.

Alcohol is a controlled substance. Like other drugs, it has an effect on how your body functions. It is also
potentially toxic and addictive. When we discuss alcohol, we tend to refer to beer, wine, and spirits. The
element that makes you intoxicated in these beverages is alcohol. The symptoms cause changes in a
person's cognition, judgment, consciousness, perception, or behavior. In addition, alcohol abuse is a
contributing factor in over 200 diseases and injuries. Other than permanent disabilities, it is responsible
for 3 million deaths worldwide each year which accounts for 5.3% that ages from 20-39 years.

We are inviting you to participate in our research entitled: Alcohol Saliva Analyzer In Detecting Alcohol
Concentration: An Experimental Research

Researchers:

Ballesteros, Frances Camille

Corpuz, Rhea Ann

Cuaresma, Ariane Lorraine

Rosario, Nhymra Joy

Ruidera, Maxine

Treyes, Karylle Arn

Turaray, Ace Lorenz

Valles, Maria Irika

Part I: Information Sheet

We are 3rd year students of Our Lady of Fatima University Antipolo - College of Medical Laboratory
Science who are currently doing a study on the Alcohol Saliva Analyzer in Detecting Alcohol
Concentration

This research will require you to provide personal information as you fill out the Personal Data Sheet
and participate in an individual, semi-structured interview. There may be some words that you may not
understand. You may ask any of our researchers as we go through the details of our research and we will
take time in explaining it to you. If you have questions, feel free to ask any of our lead researchers or co-
researcher.

We are inviting you to take part in this research since you meet the criteria that we have set for the
selection of our participants which are as follows: individuals who are capable of drinking alcohol must
be at a legal age, 18 years-old and above; student or working and must be a resident of Meralco Village
4th homes, Binangonan Rizal.

All information gathered in the course of the study will be treated as private and confidential. Your
identity will not be divulged since you will be assigned with a code during the transcription of the
interview and reporting of the results. Likewise, the results of the study will be reported as a group, and
not on individual terms. Data will be stored in a password protected hard drive and placed in a secured
storage to which only the researchers have access. All research data will be disposed of securely after a
period of one year from the time of the completion of the study

This research has been approved by the OLFU College of Medical Laboratory Science. If you have any
other concerns about the foregoing, you can ask the researchers for any questions and clarifications.
You may contact our principal investigator: Dalusong, Cyril at her email address:
[email protected]

Part II: Consent Certificate

I voluntarily agree to participate in the research conducted by Cyril Dalusong, and Medical Laboratory
Students from Our Lady of Fatima University, Antipolo. I understand that the research aims to
determine the perception and understanding of the Alcohol Saliva Analyzer In Detecting Alcohol
Concentration.

I understand that my participation is on a voluntary basis and will not be paid in exchange for my
participation. I may also withdraw from the study at any point without any penalty.

I understand that the researchers shall adequate safeguards to ensure that the information I provide will
be kept private and confidential. Results of the study will be reported as a group, and not on individual
terms. All information will be properly stored in a hard drive and will be placed in a secured storage for a
year, to which only the researcher has sole access to. Should there be any potential risks such as but not
limited to physical discomfort, pain, injury, illness or diseases brought about by the methods and
procedures of the research incurred by the respondents, the research team will not be directly held
liable for any loss, damage or causes of action in participating in the research. I have read the foregoing
information, or it has been read to me. I have had the opportunity to ask questions about it and any
questions that I have asked have been answered to my satisfaction. I consent voluntarily to participate
as a participant in this research

Date:

Signature over printed name of participant:

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