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INFORMED CONSENT
TITLE OF THE STUDY
CONDUCT OF ACTIVITIES IN THE SUBJECT "NCM 73.1 CARE OF THE CLINICALLY
ILL AND OLDER PERSON RLE”
INVESTIGATOR
Chnstian Allen Kyle R- Morales
Bachelor of Science in Nursing
Central Mindanao University
09264744766
morales christianallen@emu edu ph
PURPOSE OF THE STUDY
You are invited to take part in a school activity. But before you accept, we would like t0,
help you understand the activity and what participation you will be involved in. Please read through,
this informed consent and feel free to let us know if you need some clanficatons
STUDY PROCEDURES
Should you wish to participate, we will ask you for your personal information and your
educational background. Then, you will answer a series of questions for the physical examination.
and other questions pertaning to your health, Then you will be undergoing medical procedures,
including vital signs taking and ete We will be undergoing different types of activities that will be
required by the school for the purpase of completing this subject and leaming in the eare of older
adults ke you. You need not worry about privacy as we will not share the information, we have
gathered from this series of activities other than the subjective and objective data that we willl
gathenng.
DURATION
‘The duration of the activites that we will be undertaking will depend on the difficulty and
length that will be given to us by our clinical instructors. The activities however, will not take too
much time and not even half of the day.
VOLUNTARY PARTICIPATION
Please understand that your participation here is purely voluntary. You will decide whether
‘you will participate or not. In case you decide to participate, you will be required to fill out the
fields below for your consent as an affirmation of your participation. Should you decide to
withdraw during the activities, please do inform us Your withdrawal will not affect your
relationship with us. In ease you withdraw from this study before completion of the data collection,
(buts, ing ie Conneaut ONTACT INFORMATION
iniversity, College of Nursing.
{This study was required by the school Central Mindanao U Se ae
‘You have any questions or concems about the activities, you com
»f Nursing Dean atthe email address fpilar domagsan itera edu ph ONSENT
1 voluntarit
: activities. I have read the
formation aboy a
'y give my consent to participate
© oF the said information was 4
aforemention
ul to me. I was given the opportunity to ask
Mestions and these were answered satsfctorly and to my content
\s the participant iterate? oO
Yes No
Name of Participant: _Noemne, el. _____ porales
First Name Middle Initial Last name
Date: Gegh, 9, 2022
Signature of Participant: NS N\
Signature over Printed Name
Ihave witnessed before me the reading of the informed consent form accurately. ‘The participant
‘named herein has had the opportunity to ask questions, On bebalf of the participant, | confirm.
that the said participant has given consent to freely participate in this study.
Name of Witness:
2 Kk
irst Name
Middle Initial
Date: Soh.
Avoae
Signature of Participant: K w
Signature over Printed Name ‘meet Researcher: Chelstion Men Ey R.
Morales
First Name. ae
Middle Initial Last name
rate Ph. 4, L022
Signature of Participant: (HAS mon Fe MOUPLE S
‘Stgnature over Printed Name
