{# crate_anon/crateweb/consent/templates/consent_table.html #}
{% comment %}
template parameters:
LEAFLET_URL_CPFTRD_CLINRES_SHORT: str
patient_lookup: PatientLookup
settings: Django settings object
with_page_break: bool
{% endcomment %}
{% if with_page_break %}
<table class="consent page_break_before">
{% else %}
<table class="consent">
{% endif %}
<colgroup>
<col style="width:19%">
<col style="width:10%">
<col style="width:18%">
<col style="width:10%">
<col style="width:18%">
<col style="width:10%">
<col style="width:18%">
</colgroup>
<tbody>
{% if generic or patient_lookup.is_under_16 %}
<!-- "Under 16" box -->
<tr>
<td colspan=7>
<b>
{% if patient_lookup.is_under_15 and not generic %}
As
{% else %}
If
{% endif %}
you are under 16:
</b>
<ol>
<li>We would like to know your wishes. Please fill in
the form above and sign it.</li>
<li>If you choose not to consent, we don’t need any
signature except yours. If you consent, then because
you are under 16, we would also like the assent/consent
of your parent or guardian. Please show them the
accompanying details and this form and ask them to
countersign below to indicate that they agree.</li>
<li>If you sign to indicate your consent, but refuse to
allow your parent or guardian to see and sign, then we
must ask your clinician to sign below to confirm that
you understand fully what you’re signing.
(If you’re returning this form by post, we can
ask your clinician for their signature.)
We’re afraid we can only accept your consent via
this form if it’s signed by you and your
parent/guardian, or you and your clinician.
</li>
</ol>
Thank you!
</td>
</tr>
<tr class="persontype">
<td class="signature_label"><br><b>Parent or guardian:</b></td>
<td class="signature_label">Name:</td>
<td class="signature_box"></td>
<td class="signature_label">Signed:</td>
<td class="signature_box"></td>
<td class="signature_label">Date:</td>
<td class="signature_box"></td>
</tr>
<tr class="persontype">
<td class="signature_label"><br><b>Clinician:</b></td>
<td class="signature_label">Name:</td>
<td class="signature_box"></td>
<td class="signature_label">Signed:</td>
<td class="signature_box"></td>
<td class="signature_label">Date:</td>
<td class="signature_box"></td>
</tr>
{% endif %}
{# Are we showing two boxes? If so, insert a visual divider. #}
{# Note: you can't use brackets in Django logic expressions. #}
{% if generic %}
<tr class="tabledivider"><td colspan="7"><br></td></tr>
{% elif patient_lookup.is_under_16 and not patient_lookup.is_under_15 %}
<tr class="tabledivider"><td colspan="7"><br></td></tr>
{% endif %}
{% if generic or not patient_lookup.is_under_15 %}
<!-- MCA box -->
{# MCA doesn't apply to under-16s, but this form may go out shortly before 16th birthday #}
<tr>
<td colspan=7>
<b>If
{# let's not offend adults! #}
{% if generic or patient_lookup.is_under_16 %}
you are an adult and
{% endif %}
another adult is making decisions on your behalf:</b>
<ol>
<li>We would like the person responsible for making
decisions on your behalf to fill in the details above,
and sign below, ensuring that you yourself don’t object
to what they’ve chosen.</li>
<li>We need your clinician’s signature to confirm that you
currently lack the capacity to decide about the
question(s) being asked above, and that someone is
making decisions on your behalf.*
(If you’re returning this form by post, we can
ask your clinician for their signature.)
</li>
</ol>
Thank you!
</td>
</tr>
<tr class="persontype">
<td class="signature_label"><br><b>Representative:</b></td>
<td class="signature_label">Name:</td>
<td class="signature_box"></td>
<td class="signature_label">Signed:</td>
<td class="signature_box"></td>
<td class="signature_label">Date:</td>
<td class="signature_box"></td>
</tr>
<tr class="persontype">
<td class="signature_label"><br><b>Clinician:</b></td>
<td class="signature_label">Name:</td>
<td class="signature_box"></td>
<td class="signature_label">Signed:</td>
<td class="signature_box"></td>
<td class="signature_label">Date:</td>
<td class="signature_box"></td>
</tr>
<tr>
<td colspan=7 class="footnote">
<br>
* Note to clinicians: for decisions about clinical trials, this
must be the patient’s <i>legal representative</i>.
For decisions about other research studies or the database
traffic-light system, this must be the patient’s <i>carer or
consultee</i>.
For more details, see {{ settings.LEAFLET_URL_CPFTRD_CLINRES_SHORT }}.
</td>
</tr>
{% endif %}
</tbody>
</table>