Health Connect Registry Participant Consent Form

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Research consent form for Health Connnect Registry interviews for people who qualify to receive stipends.

About the Project

HealthLink BC is working with BC's Ministry of Citizens' Services' Government Digital Experience (GDX) Division to improve the Health Connect Registry website.
 
We are taking a human-centered design approach to this work. This includes:
  • Talking to people about their experience (user experience)
  • Creating a digital model, or prototype and recommendations
Audio Recording and Transcripts
 
To help analyze the results of the research, during the interview or workshop the interviewers may take:
  • Notes
  • Audio or video recordings
  • Photographs
Your name and any other personal identification are not associated with the recordings. The recordings may be used for training or evaluation purposes.
 
The recordings are not used for any purpose other than those described in this form, or otherwise permitted by law.
 
All recordings, transcripts and notes will be stored for the duration of the project and then securely disposed of as transitory records in accordance with the Information Management Act and related policies.
 
Confidentiality
 
Your confidentiality will be respected.  We will de-identify all notes. Please do not name yourself or others in audio or video recordings. You can choose to not be included in those recordings.
 
When individuals’ stories and experiences are recorded, confidential personal information may be shared during the interview or workshop. In compliance with the Freedom of Information and Protection of Privacy Act, all personal information will be protected using appropriate security controls.
 
Collection Notification
 
This information is collected by the Ministry of Citizens’ Services – GDX under section 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act, and will be used for the purpose of assisting analysis in the project described above. It may be used for training or evaluation purposes. If you have questions about the collection of personal information, please contact:
 
Kaitlyn Rosenburg
A/Director, Priority Content Design and Multilanguage
Government Digital Experience Division, Ministry of Citizens' Services
Kaitlyn.Rosenburg@gov.bc.ca
250-888-3449
4th floor, 617 Government St, Victoria B.C. V8W 9V1

Participant Consent to Recording

I agree to being audio recorded for the purposes described.
Missing or incorrect value
I agree to screen-capture recording for the purposes described.
Please select an option
I agree to being photographed for the purposes described.
Please select an option
I agree to being video recorded for the purposes described.
Please select an option

Consent to Participate in Interviews

I understand the following:
  • I have read and understood the Participant Consent form
  • I have had the opportunity to ask questions and have had satisfactory responses to my questions
  • I will receive a dated and signed copy of this form
Missing or incorrect value
Please provide a valid email address
Missing or incorrect valueMM/DD/YYYY

e-Gift Card

We'd like to provide you a gift card to thank you for taking the time to participate in this research.
 
You will receive a $45 electronic gift card by email from Virtual Incentives after the session. You will have the option to choose the type of gift card you want.
 
You are entitled to the gift card regardless of you completing the session.
Collection Notification
Your personal information is collected through Virtual Incentives under section 26(c) and section 26 (e) of the Freedom of Information and Protection of Privacy Act, for the purpose of delivering and confirming that you have received your e-Gift card.
 
Registration of your e-Gift card through Virtual Incentives is voluntary. Please be aware that your IP address, email address and e-Gift details will be collected by Virtual Incentives, and this information will be stored and may be accessed outside of Canada. By selecting "yes" you are consenting to your personal information (IP address, email address and e-Gift details) being stored and/or potentially accessed outside Canada. Your consent is effective as soon as you submit.
 
If you have any questions about the collection, use or disclosure of your personal information, please contact:
 
Kaitlyn Rosenburg
A/Director, Priority Content Design and Multilanguage
Government Digital Experience Division, Ministry of Citizens' Services
Kaitlyn.Rosenburg@gov.bc.ca
250-888-3449
4th floor, 617 Government St, Victoria B.C. V8W 9V1
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