ࡱ> VYUa ]bjbj :6xEbxEb xxxxx8T,;;DD(lll:::::::$<?:x:xxllL:Fxlxl::4~6lť=25: ;0;;H56A@A@,~6A@x~6(::;;A@ B >:  Telephone Screening Script <> Protocol Title: <> Hello, my name is ______________ from the department of ____________at Johns Hopkins. I am contacting you because: <<(Choose one)>> -you participated in a previous research study and agreed to be contacted about future research -you are a patient of Dr. _______ and you gave permission to be contacted -you called and left a message in response to one of our ads -you signed an authorization for future research contact -other [If none of the above apply, please include a brief statement outlining why the individual is being contacted]. <> We are working on a Johns Hopkins-approved research study about ______________________. <> Your taking part in this phone call is completely voluntary. <> Example: May I ask you a few questions to help determine if you may qualify for the study? <> <> I will be collecting information about you during this phone call. Before I ask you the screening questions, I would like to tell you about what we will be doing with the information you give us. Whether you join the study or not, the information collected today may be seen by researchers at Johns Hopkins, any sponsor of the study, and those responsible for oversight of the study. We try to make sure that the information we collect from you is kept private and used only for the research study we are discussing. If you do not agree to continue the phone call, it will not affect your current or future care at Johns Hopkins. <> <<(Choose one)>> Your personal information will not be kept if you choose not to enroll in the study or if you do not qualify to be in the study. Or Your personal information will be kept if you choose not to enroll in the study or if you do not qualify to be in the study. <> <> <> <> We have completed the telephone screening portion of our call. Do you have any questions? Do you think you would like to take part in this research? If you are interested in participating I would like to <<[describe next steps]>>: <<(Choose which of the following may apply for your study or explain other next steps)>> Examples: Set up a time to have you come in person for a screening visit Set up a time to have you come in person for your first study visit Proceed with the oral consent process <>     IRB Staff: Place Johns Hopkins Medicine Logo here upon approval.Date: Principal Investigator: Application No.: Page  PAGE 2 of  NUMPAGES 2 Telephone Screening Script July 2019 Version 2  BCDSTUWnž|tbP>P#hTfh$g56B*CJaJphDr#hTfhJ56B*CJaJphDr#hTfhZ(56B*CJaJphDrhJCJaJhz CJaJh'CJaJhwCJaJhF?hF?CJaJhZ(hZ(56B*CJphDrhyCJaJ hu?5CJ hQ5CJha:h k5CJh khSdthnd56B*phDrhTfhZ(56B*phDr hZ(5hndhZ(5hndCDUVWnW  ) ^gd,agdZ(gd0r$a$gdZ(gd##gda:gdSdtgdZ($a$gdXW     ˻˳m[I9hTfhZ(5B*CJ\phDr"hTfhZ(56B*CJ\phDr#hTfhZ(5B*CJ\aJphDr&hTfhZ(56B*CJ\aJphDrhZ(CJaJh$gCJaJ#ha:h`-56B*CJaJphDrha:CJaJh`-CJaJh- CJaJh'CJaJh kCJaJh0rCJaJhJCJaJ#hTfhJ56B*CJaJphDr#hTfhZ(56B*CJaJphDr 7 t u v 8 9 no!"#gd2gdKgd$gd}gdn^gd,a  7 s t u v Žzo[G[&hTfh$56B*CJ\aJphDr&hTfhK56B*CJ\aJphDrhK5CJ\aJh}5CJ\aJha:h}CJ\aJ"ha:h}CJ\aJmHnHu#ha:hK56B*CJaJphDrh}CJaJh -CJaJhCJaJhJCJaJh.5CJaJh.CJaJhyCJaJh'CJaJhZ(hnCJaJ 6 7 9 ; g ȸդn[G6[ h<56B*CJ\aJphDr&h<h<56B*CJ\aJphDr%h'B* CJ\aJmHnHphu h,hK56\mHnHu hP~hK56\mHnHu&hTfhK56B*CJ\aJphDr&hTfh$56B*CJ\aJphDrh$hKCJ\mHnHuh$CJ\mHnHu)hTfhK56B*\mHnHphDru)hTfh$56B*\mHnHphDru kno)  !"#ʸo`K@hK5CJ\aJ(hQ5B*CJ\aJmHnHphuhCJ\aJmHnHu"ha:h CJ\aJmHnHuh CJ\aJmHnHu"ha:h~MCJ\aJmHnHu+ha:h2B* CJ\aJmHnHphu"ha:h2CJ\aJmHnHu"ha:hK`xCJ\aJmHnHu"ha:h}CJ\aJmHnHu"ha:hnCJ\aJmHnHu#BFnoprƲ~j~^MA0 hU56B*CJ\aJphDrhhUCJ\aJ h 56B*CJ\aJphDrha:hnCJ\aJ&ha:h/m56B*CJ\aJphDrha:h/mCJ\aJ&hTfht56B*CJ\aJphDr&hTfh}56B*CJ\aJphDr&hTfh 56B*CJ\aJphDrhn5CJ\aJ)hTfhK56B*\mHnHphDru1hTfhK56B*CJ\aJmHnHphDruABFGop-mnq{|' & Fgda: & FgdLcggd#gd/mgd r/0<V,-ʹpeSA#hTfhLcg56B*CJaJphDr#hTfh'56B*CJaJphDrh5CJ\aJ#hSdth256B*CJaJphDr#hTfh 56B*CJaJphDr&hj;hSdt56B*CJ\aJphDr hSdt56B*CJ\aJphDr h 56B*CJ\aJphDr hU56B*CJ\aJphDr h}e56B*CJ\aJphDr&hj;hU56B*CJ\aJphDr-nmnpq{|'q_qM_EEhMCJaJ#hTfh<56B*CJaJphDr#hTfh\ 56B*CJaJphDr#hTfh}56B*CJaJphDr#hTfh'56B*CJaJphDrhQCJaJ#hTfh 56B*CJaJphDr#hTfhLcg56B*CJaJphDr#hh 56B*CJaJphDr#hhLcg56B*CJaJphDrh? fCJaJha:hLcgCJaJhLcgCJaJ'(  !$Ifgd k !o$Ifgd,L !o$Ifgd=Lgd#'({ ޾}uj[jOjh(CJUaJjh(h(CJUaJh(h(CJaJh(CJaJhBjhu?h khyh k5\ ha:5\ h=L5\hdPh k5\ h,L5\hCjhCUhUhDA5CJ\aJ#hTfh<56B*CJaJphDr#hTfh'56B*CJaJphDrhTfh'B*CJaJphDr +Z[\]}{s{}}}$a$gd(P^Pgd kvkd$$Ifl0*044 laytS '()*+1OPWYZ[\]պಪyhUhDA5CJ\aJhChyh(hyCJaJh!CJaJhCJaJhu?CJaJh(CJaJjh(CJUaJjh(h(CJUaJh(h(CJaJ jh(h(CJUaJ*hCJaJmHnHu*8P:p,L/ =!"#$% Dpx$$If!vh#v:V l05/ ytSs2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH >`> Normal7$8$_HmH sH tH HH Q Heading 1$$7$8$@&a$CJaJDA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List 4>@4 Title$a$CJaJ4@4 Header  !4 @4 Footer  !H"H " Balloon TextCJOJQJ^JaJ./1.  k Header CharB' AB +mComment ReferenceCJaJ4R4 +m Comment Text:a: +mComment Text Char@jQR@ +mComment Subject5\F/F +mComment Subject Char5\< <>0Revision_HmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w<v ]6  #r-']  '] !X @f̙@H 0(  0(  B S  ?[^   [^33333BB779;kkmm"" n o p       n p '' HJMOWYZ^BB779;kkmm"" n o p       n p ''HJMOWY[^g JPdH;TxgB"">]1Ăh:JjqM^R#{`؏88^8`o(. ^`hH.  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