Name:
The Hospice of Michigan - Consent for Participation in a Research Protocol:
The PEACE Program
Description:
This is a voluntary consent form that briefly describes the PEACE Program, the
reasons for gathering data, and contact information.
Category:
Organizational Tools - Informed Consent
Source:
Palliative Excellence in Alzheimer's Care Efforts (PEACE)
University of Chicago Medical Center
Section of Geriatrics (MC 6098)
5841 South Maryland Ave.
Chicago, IL 60637
Contact:
Gavin W. Hougham, Research Director
[email protected]
Greg A. Sachs, Chief, Section of Geriatrics
[email protected]
How the grantee used this instrument:
A baseline consent form used before the interviews.
Keywords:
agreement to participate, patient, caregivers, family program description, services
offered, services provided, dementia, Alzheimer's
To use this tool:
You may print and copy this tool for your own use from this site. Please credit
source.
References:
Developed specifically for this project by the project team.
To view this tool:
Left click on the download link to view the PDF document in your Web browser.
Right-click on the download link to save the document to your computer.
PDF 35 KB / 2 pages (Viewing
PDF files requires downloading and installation of the free Adobe
Acrobat Reader.)
Posted September 2004
University of Chicago: PEACE overview page
Promoting Excellence in End-of-Life Care is a national program of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit PromotingExcellence.org for more resources.
