14.3.74. crate_anon/crateweb/consent/templates/decision_form_to_patient_re_study.html

{# crate_anon/crateweb/consent/templates/decision_form_to_patient_re_study.html #}
{% extends 'base_pdf.html' %}

{% comment %}
    template parameters:
        contact_request: ContactRequest
        study: Study
        patient_lookup: PatientLookup
        settings: Django settings object
        extra_form: bool
        n_forms: int
        yellow: bool
{% endcomment %}

{% block content %}

    <div class="formtitle"><b>Deciding whether to be contacted about a
    study</b></div>

    <p>Your clinician has asked you whether you’d like to be contacted
    about this study:</p>

    {% include "study_table.html" with study=study omit_id=True only %}

    {% include "phrase_never_affect.html" %}

    <p>Would you like this research team to contact you?</p>
    <p>Please tick one option, then sign and date the form.</p>
    <table class="options">
        <colgroup>
            <col style="width:15%">
            <col style="width:85%">
        </colgroup>
        <tbody>
            <tr>
                <td class="tickbox"><b>( )</b></td>
                <td class="hangingindent">
                    <em><b>1.
                    {% if extra_form %}
                        Yes, please allow this research team to write to me. Please
                        pass on the information requested by the researchers on the
                        enclosed form, and allow them access to my full CPFT
                        records.
                    {% else %}
                        Yes, please allow this research team to write to me, and
                        allow them access to my full CPFT records.
                    {% endif %}
                    </b>
                    I understand that they will write to me about this
                    study, but that there’s no commitment to take part.
                    </em>
                </td>
            </tr>
            <tr>
                <td class="tickbox"><b>( )</b></td>
                <td class="hangingindent">
                    <em><b>2. No, do not pass on
                    my details to this research team about this study, and
                    do not allow them access to my full CPFT records.
                    </b></em>
                </td>
            </tr>
        </tbody>
    </table>

    {% if not yellow %}
        {# If yellow, the patient has already consented to this. #}
        <p>By signing you also agree that the CPFT Research Database Manager
        (who is independent of the research team) can see the information
        you send back, in order to record your choice, and pass on
        information to the researchers if that’s what you want.</p>
    {% endif %}

    {% include "signature_box_patient.html" with patient_lookup=patient_lookup %}

    {% if patient_lookup.is_under_15 %}
        <p><span class="underline">As you are under 16, please also fill in the
        box below/on the next page.</span></p>
    {% elif patient_lookup.is_under_16 %}
        {# Might have been sent out with 16th birthday approaching, etc. #}
        <p><span class="underline">If you are under 16, or another adult is
        making decisions on your behalf</span>, please also fill in the
        relevant box below.</p>
    {% else %}
        <p><span class="underline">If another adult is making decisions on your
        behalf</span>, please also fill in the box below.</p>
    {% endif %}

    <p><br></p>

    <p><em>Please return
    {% if n_forms == 3 %}
        all forms
    {% elif n_forms == 2 %}
        both forms
    {% else %}
        this form
    {% endif %}
    to {{ settings.RDBM_ADDRESS|join:", " }}. Postage is
    free, and an envelope is enclosed. You can also give
    {% if n_forms == 2 %}
        the forms
    {% else %}
        this form
    {% endif %}
    to a member of staff at CPFT.</em> If you would
    like more information from your health care professional before
    completing this form, please feel free to ask.</p>

    <p>Thank you!</p>

    {% include "consent_table.html" with settings=settings patient_lookup=patient_lookup LEAFLET_URL_CPFTRD_CLINRES_SHORT=LEAFLET_URL_CPFTRD_CLINRES_SHORT with_page_break=False %}

    {% include "office_div.html" with study=study contact_request=contact_request %}

{% endblock content %}