University of Rochester
University of Rochester
Subject Name:
Subject Name:
Research Study Name &/or #:
Research Study Name &/or #:
In Case of Emergency
Your safety is very important to us. If you should experience
ANY health-related emergency or have questions during the
study or within one-month after the study ends, please
contact us at the numbers below. Keep this card in your wallet
and give a copy to a family member.
In Case of Emergency
Your safety is very important to us. If you should experience
ANY health-related emergency or have questions during the
study or within one-month after the study ends, please
contact us at the numbers below. Keep this card in your wallet
and give a copy to a family member.
Ray Lyte, MD, PhD – Principal Investigator
Harmony Smith, RN – Study Coordinator
Ray Lyte, MD, PhD – Principal Investigator
Harmony Smith, RN – Study Coordinator
123-456-7890 (business hours)
999-999-9999 (24 Hours)
123-456-7890 (business hours)
999-999-9999 (24 Hours)
If you receive health care for any reason, please alert the
provider that you are participating in a Clinical Research Trial
by showing them this card.
If you receive health care for any reason, please alert the
provider that you are participating in a Clinical Research Trial
by showing them this card.
Contact us immediately, if you have any signs of infection
(fever, chills, cough) or develop a rash, headache, nausea,
vomiting, confusion, loss of balance, dizziness, difficulty
walking or any other concerning symptom. If you
require hospitalization, please go to Strong Memorial Hospital.
Contact us immediately, if you have any signs of infection
(fever, chills, cough) or develop a rash, headache, nausea,
vomiting, confusion, loss of balance, dizziness, difficulty
walking or any other concerning symptom. If you
require hospitalization, please go to Strong Memorial Hospital.
If you are at another facility, please have your provider call to
have you transferred to Strong Hospital by calling: 585.273.4344
If you are at another facility, please have your provider call to
have you transferred to Strong Hospital by calling: 585.273.4344
19SEP13