Surgical experiment affidavit form

The Surgical Experiment Affidavit Form is used to provide information about a surgical experiment to be conducted on a patient.

Eligibility

In general, the affidavit form will need to be filled out by the person responsible for conducting the experiment.

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Questions for Surgical experiment affidavit form

1.

Please provide your full name and contact information:

The answer should be a text input.
2.

Have you ever been a patient in a hospital or other medical facility?

The answer should be a single choice:
  1. Yes
  2. No
3.

Have you ever been a subject in a research study?

The answer should be a single choice:
  1. Yes
  2. No
4.

Have you ever been a surgical patient?

The answer should be a single choice:
  1. Yes
  2. No
5.

Are you currently taking any medications?

The answer should be a single choice:
  1. Yes
  2. No
6.

Do you have any medical conditions?

The answer should be a single choice:
  1. Yes
  2. No
7.

Are you pregnant or breastfeeding?

The answer should be a single choice:
  1. Yes
  2. No
8.

Do you have any allergies?

The answer should be a single choice:
  1. Yes
  2. No
9.

Do you have any religious or cultural beliefs that might affect your participation in a surgical experiment?

The answer should be a single choice:
  1. Yes
  2. No
10.

Would you be willing to sign a consent form allowing your participation in a surgical experiment?

The answer should be a single choice:
  1. Yes
  2. No

Similar Ideas

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Here are some FAQs and additional information
on
Surgical experiment affidavit form

What is a surgical experiment?

A surgical experiment is a research study in which a new surgical procedure or treatment is tested on human subjects.

Why are surgical experiments conducted?

Surgical experiments are conducted in order to test the safety and efficacy of new surgical procedures or treatments.

Who can participate in a surgical experiment?

In order to participate in a surgical experiment, subjects must meet the eligibility criteria specified by the researcher conducting the study.

What are the risks of participating in a surgical experiment?

The risks of participating in a surgical experiment vary depending on the specific procedure or treatment being tested. Potential risks may include, but are not limited to, pain, bleeding, infection, and scarring.

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