The Hospice of Michigan - Consent for Participation in a Research Protocol: The PEACE Program
This is a voluntary consent form that briefly describes the PEACE Program, the reasons for gathering data, and contact information.
Organizational Tools - Informed Consent
Palliative Excellence in Alzheimer's Care Efforts (PEACE)
University of Chicago Medical Center
Section of Geriatrics (MC 6098)
5841 South Maryland Ave.
Chicago, IL 60637
Gavin W. Hougham, Research Director
Greg A. Sachs, Chief, Section of Geriatrics
How the grantee used this instrument:
A baseline consent form used before the interviews.
agreement to participate, patient, caregivers, family program description, services offered, services provided, dementia, Alzheimer's
To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.
Developed specifically for this project by the project team.
To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
PDF 35 KB / 2 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)
Posted September 2004
University of Chicago: PEACE overview page
Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.