전문 번역가, 번역 회사, 웹 페이지 및 자유롭게 사용할 수 있는 번역 저장소 등을 활용합니다.
consent no: consent form for research “detection of fluoroquinolones concentration and fluoroquinolone resistant genes amongst fluoroquinolone resistant biofilm and non biofilm producing bacteria isolated from covid-19 patients” lab no: d m y date: patient information name: ………………………………................... age: …………..... gender: male female others occupation: ...………….. reporting centre: ………………………………................................................................... mobile: ………………………………................... telephone: ………...……. residing address: ………………………… permanent address: ……………..……... i, ………………………………………., hereby provide my informed consent to get my blood/serum and blood/urine/body fluids/others (……………………) tested for assessing bacterial co-infections and also evaluating the serum levels of procalcitonin. the significance, relevant information & pre-test counseling have been provided to me. i have been explained fully the probable side effects too. i value and respect the outcome of this research and i am volunteering the research as per my free will and have not been influenced by any person. i have the right to withdraw from the study at any time without in any way affecting my medical care. i understand that my result shall be kept confidential. i authorize the following person/ agency to collect the sample/report on my behalf. signature/thumb print (any one) self sign right left ref. agency sign right left guardian sign right left *in case of minors, consent form to be signed by either of the parents / legal guardian *in adoption cases, consent form to be signed by orphanage / ngo / adopting parents *in case of incapacitated or hospitalized patients, consent to be signed by next of kin or doctor collected by: ...................................... signature: ......................................
마지막 업데이트: 2020-12-16
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