Study Related Progress Note
Principal
Investigator
Study Title/
Protocol #
Patient Name : _______________________________ Subject # : ___________________
Discussed Informed Consent with subject and subject was given adequate opportunity to read
and ask questions before signing. All questions were answered; subject initialed each page and
signed informed consent after verbalizing understanding. No research or protocol procedures
were completed prior to informed consent being signed. The subject was given a copy of
Informed Consent for their records and a copy placed in medical charts.
Comments (if applicable):
_______________________________________
Signature of Person Obtaining Informed Consent
___________________
Printed Name
Date___________
Time_________
Created by Kirtanaa Vorula
Drexel University College of Medicine