Structure
"
] ; #
fhir:url [ fhir:v "https://kind-lab.github.io/vbai-fhir/Questionnaire-bridge2aieconsentmainicfusfenglishschema"^^xsd:anyURI] ; #
fhir:version [ fhir:v "2.2.0"] ; #
fhir:title [ fhir:v "bridge2ai_econsent_main_icf_usf_english_schema"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:date [ fhir:v "2024-05-29T18:29:14Z"^^xsd:dateTime] ; #
fhir:publisher [ fhir:v "KinD Lab"] ; #
fhir:contact ( [
fhir:name [ fhir:v "KinD Lab" ] ;
fhir:telecom ( [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://fhir.kindlab.sickkids.ca" ]
] )
] ) ; #
fhir:item ( [
fhir:linkId [ fhir:v "page_1" ] ;
fhir:text [ fhir:v "page_1" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page2" ] ;
fhir:text [ fhir:v "page2" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page3" ] ;
fhir:text [ fhir:v "page3" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page_4" ] ;
fhir:text [ fhir:v "page_4" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page_5" ] ;
fhir:text [ fhir:v "page_5" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page6" ] ;
fhir:text [ fhir:v "page6" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page7" ] ;
fhir:text [ fhir:v "page7" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page8" ] ;
fhir:text [ fhir:v "page8" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "page_9" ] ;
fhir:text [ fhir:v "page_9" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "consent_usf_question" ] ;
fhir:text [ fhir:v "Consent to Take Part in Research and Authorization for the Collection, Use and Disclosure of Health Information: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. I understand that by filling out the best future contact below, I am consenting to be contacted in the future for further voice data collection if long term follow up is required as part of an eventual extension of this grant after the 4-year duration.Please select one of the three statements below that you consent to." ] ;
fhir:type [ fhir:v "choice" ] ;
fhir:answerOption ( [
fhir:value [ fhir:v "I consent to having all data I submit shared only with the researchers of this study." ]
] [
fhir:value [ fhir:v "I consent to having all data I submit shared with the researchers of this study and to having my audio recordings and de-identified written responses shared with other qualified researchers." ]
] [
fhir:value [ fhir:v "I consent to having all data I submit shared with the researchers of this study and to having my audio recordings and de-identified written responses shared with other qualified researchers as well as publicly in the form of an open-source database." ]
] )
] [
fhir:linkId [ fhir:v "consent_usf_signature" ] ;
fhir:text [ fhir:v "Signature of Person Taking Part in Study\n[Authorization]" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "consent_usf_name" ] ;
fhir:text [ fhir:v "Printed Name of Person Taking Part in Study" ] ;
fhir:type [ fhir:v "string" ]
] [
fhir:linkId [ fhir:v "consent_usf_date" ] ;
fhir:text [ fhir:v "Date" ] ;
fhir:type [ fhir:v "string" ]
] ) . #
# -------------------------------------------------------------------------------------
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
![\".\"](\"tbl_spacer.png\") ![\".\"](\"icon_q_root.gif\" "\\"QuestionnaireRoot\\"") | Questionnaire | https://kind-lab.github.io/vbai-fhir/Questionnaire-bridge2aieconsentmainicfusfenglishschema#2.2.0 | ||
![\".\"](\"tbl_vjoin.png\") ![\".\"](\"icon-q-string.png\" "\\"String\\"") page_1 | page_1 | 0..1 | string | |
| page2 | page2 | 0..1 | string | |
| page3 | page3 | 0..1 | string | |
| page_4 | page_4 | 0..1 | string | |
| page_5 | page_5 | 0..1 | string | |
| page6 | page6 | 0..1 | string | |
| page7 | page7 | 0..1 | string | |
| page8 | page8 | 0..1 | string | |
| page_9 | page_9 | 0..1 | string | |
![\".\"](\"icon-q-coding.png\" "\\"Coding\\"") consent_usf_question | Consent to Take Part in Research and Authorization for the Collection, Use and Disclosure of Health Information: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. I understand that by filling out the best future contact below, I am consenting to be contacted in the future for further voice data collection if long term follow up is required as part of an eventual extension of this grant after the 4-year duration.Please select one of the three statements below that you consent to. | 0..1 | choice | Options: 3 options |
| consent_usf_signature | Signature of Person Taking Part in Study\n[Authorization] | 0..1 | string | |
| consent_usf_name | Printed Name of Person Taking Part in Study | 0..1 | string | |
![\".\"](\"tbl_vjoin_end.png\") consent_usf_date | Date | 0..1 | string | |
Options Sets
Answer options for consent_usf_question
- I consent to having all data I submit shared only with the researchers of this study.
- I consent to having all data I submit shared with the researchers of this study and to having my audio recordings and de-identified written responses shared with other qualified researchers.
- I consent to having all data I submit shared with the researchers of this study and to having my audio recordings and de-identified written responses shared with other qualified researchers as well as publicly in the form of an open-source database.