ROP Screeners and Treatment Providers Registry: Philippine Retinopathy Of Prematurity Network
This project aims to provide a registry of ophthalmologists who can perform ROP screening and treatment in the Philippines. The primary utility of this registry is to give accessible information to pediatricians, general ophthalmologists, parents and other stakeholders.
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Consent Form to Participate
Purpose of Study: You are being asked to participate in a research study. Before you decide to participate in this study, it is essential that you understand why the research is being done and what it will involve. Please read the following information carefully. Please ask the researcher if there is anything that is not clear or if you need more information.

This study aims to provide a registry of ophthalmologists who can perform ROP screening and treatment in the Philippines. The primary utility of this registry is to give accessible information to pediatricians, general ophthalmologists, parents, and other stakeholders. This study has been reviewed and approved by the Ospital ng Makati Research and Ethics Board (OMREB).

Study Procedures: A google form will be sent out individually to members of the Vitreo-Retina Society of the Philippines and Philippine Society of Pediatric Ophthalmology and Strabismus, along with the consent for project participation and data publication. It will only take 5 to 10 minutes to complete the online questionnaire.

Risks: There are no identifiable risks in the conduct of this study. You may decline to answer any or all questions, and you may terminate your involvement at any time if you choose. This study will not recruit any identified vulnerable population. Standard infection prevention protocol during the recruitment and survey is not needed since it will be conducted online.

Benefits: Direct beneficiaries of this study are the preterm infants who need ROP screening and treatment. Other stakeholders who will benefit from the registry are parents, pediatricians/neonatologists, and general ophthalmologists, who will have access to information about the nearest health care provider. There will be no immediate benefits, compensation, or remuneration to the participants of this study. There is also no anticipated payment to the participant. All eligible participants based on the inclusion criteria will be invited to participate in this study.

Confidentiality: Only the name of the health care provider, name of health care institution, city, region, and ROP treatment services available will be published on the PROP-Net website upon the consent of the study participant. Other identifiers will remain confidential in the digital database stored in a password-protected computer according to the Data Privacy Act.

Contact Information: If you have any questions about this study, you may contact the researcher, Dr. Rachelle Anzures at 09228722463. If you have questions regarding your rights as a research participant, or if problems arise that you do not feel you can discuss with the primary investigator, please get in touch with the Institutional Review Board at 8882-6316 local 446.

Voluntary Participation: Your participation in this study is voluntary. It is up to you to decide whether or not to take part in this study. If you choose to take part in this study, you will be asked to signify your consent by clicking the AGREE button. After you have consented to participate, you are still free to withdraw at any time and without giving a reason. Starting from this study will not affect your relationship, if any, with the researcher. After publication, your data will be returned to you or destroyed if you withdraw from the study.

Consent: I have read and understand the provided information and have had the opportunity to ask questions. I know that my participation is voluntary and that I am free to withdraw at any time, without reason and cost. I agree to participate in this study and express my willingness by clicking the AGREE button.

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