知情同意书

---
name: informed-consent-form
language: en
description: Drafts regulatory-compliant informed consent forms for healthcare procedures, clinical trials, research participation, or professional services. Incorporates HIPAA, FDA, IRB/Common Rule, and ICH-GCP requirements as applicable. Use when drafting surgical consent, research participant agreements, clinical trial consent, or treatment authorization forms.
---

# Informed Consent Form

Drafts a defensible informed consent form satisfying disclosure obligations and documenting voluntary, knowing authorization.

## Quick Start

Gather before drafting:

1. **Jurisdiction** — which consent standard applies (professional, reasonable person, or subjective)
2. **Regulatory framework** — HIPAA, FDA, IRB/Common Rule, ICH-GCP, state rules
3. **Procedure details** — protocol, personnel, timeline, devices, medications
4. **Participant population** — capacity issues, language needs, literacy level
5. **Institutional requirements** — templates, mandatory language, formatting

## Core Sections

### 1. Procedure Description

| Element | Include |
|---|---|
| Process overview | Prep, intervention, follow-up in plain language; define terms parenthetically |
| Timeline | Frequency, duration, total commitment |
| Personnel | Qualifications of those performing/supervising |
| Materials | Equipment, medications, devices with lay explanations |
| Participant burden | Physical demands, time, lifestyle changes, emotional impact |

### 2. Risk Disclosure and Benefits

**Risk frequency tiers** — use consistently:

| Tier | Frequency | Label |
|---|---|---|
| Common | >10% | "commonly" / "frequently" |
| Occasional | 1–10% | "occasionally" / "sometimes" |
| Rare | <1% | "rarely" |
| Isolated | Case reports only | "in isolated cases" |

For each material risk: nature of harm, severity, temporary vs. permanent, mitigation.

Benefits: realistic expectations only, no guarantees. State if experimental. Include statistical context when available.

### 3. Alternatives and Right to Refuse

- [ ] Each viable alternative with comparative risk/benefit/cost analysis
- [ ] Less invasive options and conservative management
- [ ] Option to decline — natural course explained factually
- [ ] No-coercion language: refusal won't cause abandonment or care loss
- [ ] If no alternatives exist, state clinical basis

### 4. Privacy and Information Governance

- [ ] Data collected, purpose, retention, access (care team, researchers, regulators)
- [ ] Applicable privacy framework (HIPAA, FERPA, state statutes)
- [ ] Confidentiality limits: mandatory reporting, court orders, safety exceptions
- [ ] Secondary uses require separate consent (QI, teaching, research, publication)
- [ ] Safeguards described; participant rights to access/correct data
- [ ] Certificate of Confidentiality status (research)

### 5. Participant Rights and Withdrawal

- [ ] Unconditional right to withdraw without penalty
- [ ] Withdrawal process: contact, written notice, data/specimen disposition
- [ ] Honest disclosure of practical limitations (irreversible steps, published aggregates)
- [ ] Right to ask questions at any point
- [ ] Contact info for questions, adverse events, complaints
- [ ] Financial transparency: covered costs, out-of-pocket, compensation

### 6. Signature and Execution Block

Include all that apply:

**Primary participant** — attestations: read/understood, opportunity to ask questions, voluntary consent. Signature, printed name, date.

**Authorized representative** (if participant lacks capacity) — signature, printed name, date, relationship, legal basis for authority.

**Person obtaining consent** — attestation that procedure was explained and participant demonstrated understanding. Signature, printed name/title, date.

**Witness** (when required by regulation/policy) — attestation of observing consent process. Signature, printed name, date.

**Separate opt-in/opt-out blocks** for each ancillary authorization:
- Photography/video
- Specimen use for future research
- Contact for additional studies
- Third-party information release

**Document control footer**: version number, effective date, supersedes date, page X of Y.

Include statement: participant receives a complete signed copy.

## Drafting Rules

1. **Jurisdiction-first** — confirm applicable consent standard before drafting; requirements vary by state
2. **Plain language** — active voice, short sentences, common words; define technical terms parenthetically; 12pt minimum font
3. **Material risk standard** — disclose any risk a reasonable person would consider significant; err toward over-disclosure
4. **No guarantees** — use "may," "expected," "typical"; never promise outcomes
5. **Selective consent** — participants must decline ancillary authorizations without affecting primary consent
6. **Capacity accommodations** — address literacy, language, cognitive limitations in the attestation

## Pitfalls

- **Skipping jurisdictional analysis** — consent standards differ significantly by state; a form valid in one may be inadequate in another
- **Burying risks** — material risks must be prominent, not hidden in dense paragraphs
- **Coercive framing** — refusal language must be neutral; never imply negative consequences for declining
- **Missing withdrawal limits** — state honestly which steps are irreversible; omission undermines defensibility

## Final Check

- [ ] Applicable regulatory frameworks identified and addressed
- [ ] All material risks disclosed with frequency tier labels
- [ ] Alternatives section includes option to decline
- [ ] Privacy section covers confidentiality limitations
- [ ] Signature blocks match participant population (capacity, witnesses)
- [ ] Ancillary authorizations are separate opt-in/opt-out
- [ ] Document control footer with version, date, pagination
- [ ] Flag for review by legal counsel, compliance, and IRB/ethics committee (if research)