Statement of Person Obtaining Informed Consent: 919297

Informed consent to participate in Research of Mr. X and authorization to collect, use and share health information   Information to consider before participating in the research study Title: Evaluation and comparison of the effectiveness of a fourth-generation rapid HIV test to the conventional ELISA technique   Overview: Through this document, you are being requested to be a part of the research study. This document contains vital information that would help you form a decision that whether or not you would like to be involved in the research.     Research Authority: The research study is headed by Dr. X, who is a Post Doc. in Molecular Medicine from the University of Ohio and is the principal investigator for the research study. The research would be conducted in the Biotechnology laboratory of Michigan. Mr. A and Ms. B are also involved in the project who are Post Doc from the University of Michigan in Molecular Medicine and are led by Dr. C, who is the Head of the Department of the Human Genetics Department of University of Michigan.   Study Details: The research study would be conducted in Michigan and would be funded by the National Institute of Health. The primary objective of the research study would be to evaluate the effectiveness of the fourth generation HIV testing technique against the conventional ELISA technique. The fourth generation technique has been studied to be extremely specific and twice more specific compared to the ELISA technique. The technique has successfully passed through animal trials and this research forms the first time when the testing would be done on human biological samples of blood, urine and saliva.   Participants: You are requested to be a part of the research study because you are eligible in terms of the following parameters: You belong to the age group that comprises of the highest reported case HIV/AIDS You are a healthy individual You fall under the target community that has the highest prevalence of HIV/AIDS as per global statistics     Voluntary Participants:   Benefits, Compensation and Risk:   Confidentiality:     Reason for Participation:     Procedure:     Total Participants:     Voluntary Participation/ Option for withdrawal:     Added Benefit:     Involved Risks:   Remuneration:   Involved expenditure:  Reimbursement in case of injuries: Privacy:   What if a novel information becomes available?     Query addressal: Authorization to use and disclose HIPAA language:     Consent to Take Part in Research and Authorization for the Collection, Use and Disclosure of Health Information   It is up to me to decide whether I want to agree to allow my blood/tissue to be used and stored for future research. I understand that I do not have to agree to the use and storage of my blood/tissue in order for me to take part in the study that has been explained to me. I agree to the choice(s) initialed below. _______ I agree to provide blood for use in this research project. _______ I agree to provide blood for use in future research.
I freely give my consent to take part in this study and authorize that my health information as agreed above, be collected/disclosed in this study]. I understand that by signing this form I am agreeing to take part in research. I have received a copy of this form to take with me. _______________________________________________________________                              Signature of Person Taking Part in Study                                                                  Date
[Authorization]                                                                                       Statement of Person Obtaining Informed Consent and Research Authorization I have carefully explained to the person taking part in the study what he or she can expect from their participation. I confirm that this research participant speaks the language that was used to explain this research and is receiving an informed consent form in their primary language. This research participant has provided legally effective informed consent.   
_______________________________________________________________      _______________ Signature of Person Obtaining Informed Consent                                                     Date     ________Mr. Alexis_______________________________________________________ Printed Name of Person Obtaining Informed Consent