Indiana Clinical and Translational Sciences Institute (CTSI) Volunteer Participant Registry (All IN for Health)
You are signing up to take part in a volunteer registry called All IN for Health that is operated by the Indiana CTSI at the Indiana University School of Medicine (IUSM).
The purpose of this registry is to match individuals with any research studies being conducted at Indiana University and its partnering institutions. You will be one of many volunteers throughout Indiana.
We will ask you to provide the following information:
* Registrant's full name (and in case of a dependent, also contact's full name)
* Contact Information (Address, phone, email)
* Date of birth
* Demographics (Gender, Race, Ethnicity)
* Family and Medical History
Your information will help us match you to research. If you are matched to a study, you will receive an email from us letting you know how to take part in that study.
BENEFITS AND RISKS OF TAKING PART IN THE REGISTRY
* There is no cost to participate in this registry and you will not receive any payment for taking part.
* Signing up through the All IN for Health Volunteer Registry allows you to be contacted by researchers who would like to tell you about their study.
* The risks of taking part are minimal. There is a risk of the loss of confidentiality; however, every effort is taken to maintain privacy and confidentiality of your information at all times.
* The purpose of this registry is to share your information with researchers who would like to contact you for research studies you or a loved one may be eligible for. Only information relevant to the study will be shared with the research team such as contact information.
* We might use some or all of the information collected in this registry in future research unrelated to matching you to research studies. If so, we would remove information identifying you (name, address, phone, email) before using or sharing.
* Every effort will be made to ensure your information is kept safe and secure. However, we may need to disclose information if required by law and/or individuals or organizations that oversee the conduct of research studies.
* The Indiana CTSI cannot guarantee absolute confidentiality and privacy since these individuals or organizations may not be held to the same legal privacy standards as are doctors and hospitals.
* Other organizations may inspect and/or copy your research records for quality assurance and data analysis including the study investigator and his/her research team, the IU Institutional Review Board or its designees, and (as allowed by law) state or federal agencies (specifically the Office for Human Research Protections (OHRP)).
TAKING PART IN THE All IN FOR HEALTH VOLUNTEER REGISTRY IS COMPLETELY VOLUNTARY.
* By providing your information, you are only stating you would like to be contacted for research studies.
* You are not obligated to take part in any study you are not interested in and your decision does not affect your being contacted at a later time.
* You may choose not to take part or request to have your name removed from the registry at any time and for any reason.
* If you wish to modify your information or remove your name from the registry, you can log into your account and change it at any time. If you need help doing this, please contact the Indiana CTSI at email@example.com or by calling 317-278-2176 or 888-264-0005.
* Your decision whether or not to participate in this registry will not affect your current or future relations with the Indiana University School of Medicine or your physicians' offices.
FOR QUESTIONS ABOUT THE REGISTRY, please contact the Indiana CTSI by email at firstname.lastname@example.org or by phone at (317) 278-2176 or Toll-free at 1-888-264-0005.
You may also contact the IU Human Subjects Office at (317) 278-3458 or 1-800-696-2949 to ask questions about your rights as a research participant or to discuss problems, voice any complaints or concerns about a research study, or to obtain information, or offer input.
* By checking below, you agree that the Indiana CTSI can release you information to the research study team so that you may be contacted for research studies.
* You also agree that the Indiana CTSI may access, keep or share your profile information if required to do so by law.
* You can refuse to take part in any study and drop out of this registry for any reason.
* The All IN for Health Volunteer Registry is approved by the IU IRB study #1105005444.