Va Form 10-1086 - Research Consent Form

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RESEARCH CONSENT FORM
DATE (MM/DD/YYYY)
SUBJECT NAME
TITLE OF STUDY
PRINCIPLE
VAMC
INVESTIGATOR
DESCRIPTION OF RESEARCH BY INVESTIGATOR 1.Purpose of study and how long it will last: 2. Description of
study including procedures to be use:; 3. description of procedures that may result in disconfort or inconvenience:
4. Expected risks of study: 5. Expected benefits of study: 6. Other treatment available: 7. Use of research results:
8. Special circumstances.
SUBJECT'S IDENTIFICATION
Page 1 of 1
VA FORM
10-1086
MAR 2006

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