Promoting Excellence : Consent for Participation in a Research Protocol: The PEACE Program

Name:
The Hospice of Michigan - Consent for Participation in a Research Protocol: The PEACE Program

Description:
This is a voluntary consent form that briefly describes the PEACE Program, the reasons for gathering data, and contact information.

Category:
Organizational Tools - Informed Consent

Source:
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

Contact:
Gavin W. Hougham, Research Director
[email protected]

Greg A. Sachs, Chief, Section of Geriatrics
[email protected]

How the grantee used this instrument:
A baseline consent form used before the interviews.

Keywords:
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.

References:
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 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


# UCP02, type:informed_consent

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.

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