ࡱ> orn bjbj *F}c}c 4U66}84R\" [[[[[[[$0^`[[  \j!j!j!d [j![j!j!RSZnyHpW\["\0R\WxaaSZSZa [j![[ R\a6 C: SAINT LOUIS UNIVERSITY Institutional Review Board Waiver of Written Consent Principal Investigator (PI):IRB #:First Name / Last Name CredentialsTitle of Project: When waiving written consent, the IRB requires that you submit (upload) a document/script/letter for participants that addresses the eight required elements of consent as stated in 45 CFR 46.116(a)(1-8). You may use or refer to the  HYPERLINK "http://www.slu.edu/Documents/provost/irb/model_recruitment_statement.doc" \t "_blank" 鶹Ƶ Model Recruitment Statement when preparing this document. In addition, please complete the items below. PLEASE JUSTIFY HOW YOUR RESEARCH MEETS AT LEAST ONE OF THE FOLLOWING CRITERIA * The consent document would be the only record linking the subject to the research, and the principal risk is the potential harm resulting from a breach of confidentiality.  The research involves no more than minimal risk and involves no procedures for which a written consent is normally required outside of research.  The subjects or legally authorized representatives are members of a distinct cultural group or community in which signing forms is not the norm, the research presents no more than minimal risk of harm to subjects, and there is an appropriate alternative mechanism for documenting that informed consent was obtained.  PLEASE INDICATE THE CONSENT PROCESS TO BE USED IN LIEU OF WRITTEN CONSENT. * VERBAL CONSENT: Verbal consent must be documented in the research record. IMPLIED CONSENT: Indicate how implied consent will be given by subjects. (e.g., by continuation of an interview over the telephone or return of questionnaire, etc.).  OTHER:  The information listed in the waiver application is accurate and all research staff will comply with the consent regulations and the waiver criteria. I assure that the information I obtain as part of this research (including protected health information) will not be reused or disclosed to any other person or entity other than those listed on this form, except as required by law. If at any time I want to reuse this information for other purposes or disclose the information to other individuals or entity I will seek approval by the IRB. Signature of Principal Investigator (PI)Date First Name / Last Name CredentialsPrinted Name of Principal Investigator (PI) FOR IRB USE ONLY APPROVED ____________________________________________ IRB Authorized Representative Date   Federal Regulations: 45 CFR 46.116(d)(1-4); An IRB may approve a consent procedure which does not include, or which alters, some or all of the elements of informed consent set forth in this section.  Note: Research staff is defined as ALL study personnel (including PI) that is involved in the research.     PAGE  PAGE 1 Revised: 01/2019 23:=ELMNPklmnqruvwͻ̓qbqRq?qR%hChq56CJOJQJ\^JhChqCJOJQJ\^Jh8&5CJOJQJ\^J"hChq5CJOJQJ\^JhChqOJQJ^J0jhChj!0J5CJ OJQJU^JaJ #hCh-5CJ OJQJ^JaJ #hChj!5CJ OJQJ^JaJ #hChq5CJ OJQJ^JaJ hChqCJOJQJ^J"hChq5;CJOJQJ^J23NOPmnuv  $If $5$7$8$H$Ifgdq$a$gdq vwx+ $5$7$8$H$Ifkd$$IfTU\ g\ 'F F^  t0'44 BBapytTwx   l 쵣쒵rarLrL9Lr$hCh-0J"CJOJQJ^JaJ)jhCh-CJOJQJU^JaJ hChCCJOJQJ^JaJ hCh-CJOJQJ^JaJhCh8_AKH OJQJ^J hChqCJOJQJ^JaJ"hChq5CJOJQJ\^JhChqOJQJ^J) *hChq6CJOJQJ\^JaJ)hChq6CJH*OJQJ\^JaJ&hChq5CJOJQJ\^JaJ5, $Ifgd}kd"$$IfTF g' FS  t0'    44 BapytT $5$7$8$H$Ifl m je`UI@ gd-  & F, gd-  !gdBPH!gd-gdqkd0$$IfT0 'F   t 0'44 Bap ytTl m i j k n o r      A B C F G H չծ}oaSǹhCh/aOJQJ\^JhCh8&OJQJ\^Jh8&h-OJQJ\^JhCh-OJQJ^JhChavOJQJ\^Jh-OJQJ\^JhOJQJ\^JhavOJQJ\^JhChOJQJ\^JhChBPHOJQJ\^JhChqOJQJ\^JhCh-OJQJ\^JhChOJQJ\^J j k l m n o LA  !gdqwkd$$Ifl`'#  t 0644 lap yt(u !$Ifgd3 !$Ifgd(u !^gdBPH & F+ !gd-o      RC !^gdavwkd$$Ifl`'#  t 0644 lap yt(u !$Ifgd3 !$Ifgd(u gd- & F+ !gdBPH B C D E F G H [PP  !gd-wkd6$$Ifl`'#  t 0644 lap yt=a !$Ifgd=a !^gdav & F+ !gdavH  !$Ifgd3 !$Ifgd(u  !gd !^gd8& & F. !gd- !h^hgd- & F, !gd-xj[L !$Ifgd3 !$Ifgd(u & F. !gd/a !^gd/awkd$$Ifl`'#  t 0644 lap yt(u34|wwwwwwqee $5$7$8$H$If$Ifgdq  !gdwkdh$$Ifl`'#  t 0644 lap yt(u  234>?@Pklpr󹧹n\#hCh5CJOJQJ^JaJ#hCh8_ACJOJQJ\^JaJ)hChq6CJH*OJQJ\^JaJ"hChq5CJOJQJ\^J#hChq5CJOJQJ^JaJhChqOJQJ^JhChOJQJ^JhChBPHOJQJ^J%jhChj!0JOJQJU^JhCh8_AOJQJ^JF71$If$5$7$8$H$Ifgdqkd$$If4FZq`'N  t0'6    44 awpyt $5$7$8$H$If5) $5$7$8$H$Ifkd$$If4FZq`'FBF  t0'6    44 Bawpyt$$5$7$8$H$Ifa$s $5$7$8$H$If$Ifzkd$$IfZ`''  t 0'644 awp yt? $5$7$8$H$Ifjkd$$IfZq t0'644 awyt?@lt $5$7$8$H$Ifkd^ $$IfZqF  t 0'644 Bawp ytlmnopqr}}}}}q $$Ifa$gdgdq}kd# $$IfZqF  t 0'644 Bawp ytygXXXO $Ifgdq T$Ifgdq$ T$Ifa$gd T$Ifgdqvkd $$IfTlGO  064 lap yt(uT.234578:;=>@AGHIKLRSܾwsogogogogo]W]Ws]W] h-0Jjh-0JUjhcUhch-h/aCJOJQJ^JaJ h/ah/aCJOJQJ^JaJ hj!h-CJOJQJ^JaJ-jhj!h-0JCJOJQJU^JaJhCh8_AOJQJ^J hChCJOJQJ^JaJ hCh8_ACJOJQJ^JaJ#hCh8_A5CJOJQJ^JaJ 34679:<=?@I&`#$gdqgkd $$IfTlGO064 laytTIJKVgdq  P h]h&`#$h]hSTUV_aefɽɰhCh8_AOJQJ^Jhch-hh-OJQJ^Jh-CJOJQJ^JhCJOJQJ^Jhh-CJOJQJ^J h-0Jjh-0JUhM0JmHnHu (/ =!"#$%  $$If!vh#v #v#v#v^:V U  t0',5 555^/ 4 BBapytT $$If!vh#v #v#vS:V   t0',5 55S/ 4 BapytT$$If!vh#v #v:V   t 0',5 5/ 4 Bap ytT$$If!vh#v#:V l  t 065#ap yt(u$$If!vh#v#:V l  t 065#ap yt(u$$If!vh#v#:V l  t 065#ap yt=a$$If!vh#v#:V l  t 065#ap yt(u$$If!vh#v#:V l  t 065#ap yt(u$$Ifw!vh#v#vN#v:V 4  t0'6+,55N5/ 4 awpyt$$Ifw!vh#v#vN#v:V 4  t0'6+,555/ 4 Bawpyt$$Ifw!vh#v':V   t 0'6,5'/ 4 awp yt$$Ifw!vh#v:V  t0'6,5/ 4 awyt$$Ifw!vh#v:V   t 0'6,5/ 4 Bawp yt$$Ifw!vh#v:V   t 0'6,5/ 4 Bawp yt$$If!vh#v:V l  0654ap yt(uT$$If!vh#v:V l0654aytT #v666666666vvvvvvvvv6666686666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@666_HmH nH sH tH 8`8 Normal_HmH sH tH @@  Heading 1$$@&a$5\JJ  Heading 2$ T@& 5CJ\>>  Heading 3$$@&a$58@8  Heading 4$@&5BB  Heading 5$$@&a$5CJ>>  Heading 6$@& >*CJ]BB  Heading 7$$@&a$5CJDA`D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 4@4 Header  !4 @4 Footer  !.)@. Page NumberHC"H Body Text Indent CJOJQJ0"0 Caption5\>BB> Body Text5CJOJQJ\RR\ Body Text Indent 2p0^p`0 CJOJQJXSbX Body Text Indent 30^`0OJQJ>Pr> Body Text 2  5JQJ Body Text 3 7$8$H$ B*CJph4>4 Title$a$5CJJJ Subhead dx:@CJ OJQJ]6@6  Footnote Text@&`@ Footnote ReferenceH*HH 0 Balloon TextCJOJQJ^JaJN/N 0Balloon Text CharCJOJQJ^JaJ./. q Footer Charjj q Table Grid7:V 0 J^@J -0 Normal (Web)!dd[$\$CJaJ4U`!4 -0 Hyperlink >*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVq1u`X=:tڣf{Xx {dV=|kPo۵(h[x )IеnW[@;0PDbRy( "IROnVxCD' bJZ65I[adH+^D )>s=h ۟~7zWo^=[Qr||[?|̦ o{O=4?}}L$Xx%@|Ư'11%i$P,c[GD7sH5. 4kIƉZKTPBM HN7|nB#L7^`!\29pCH3nMb#$.'19b%+vJ~.!DI;DPz l 2I ͚;|y3+~Dؕjw0e1vdǪzO^I57y+d8bnv 4?6CK\M#= ċ(0'1 zxpWc/_X4/A_[)^&(fp[_NiK7@wd5= I?>q샏ꚝΡ5Ӵ>3m=͡|7;:۱&?8ټ<}9H}]Ru Vx~p{3AsP~\v!cZ 6JOw׃SB HfЖ gpj*4nR2BM} rfw[BfV= vͅh7/sɳ ̲B3뤓eH=J_:hn$O\ʧFn;/x.M#+d,W87+IwOťwF) uepwPϬ pV$2v Sv(C8L\~+l`k& Y iTU#p~XHYHeʹ,fͰ-;Y7XmM 9ͬYMm*/稺W(r2bUGڱ]]HYUcF8U~ۍZZnJmi}kn^l L 36 F TTTWwl S "v o  H ?lI  ! X  W!!48@0(  B S  ? 3 4 6 7 9 : < = ? @ H K U wyz } & ( 4 6 7 9 : < = ? @ 333MMklG 3 4 6 7 9 : < = ? @ U f MMklG 3 4 4 6 7 9 : < = ? @ H K U V f +Iy+&?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]_`abcdeghijklmpqutvwxyz{|}~Root Entry FsysData $1Table,NbWordDocument *FSummaryInformation(^DocumentSummaryInformation8fMsoDataStorebymyLEM1VOOOQ==2bymyItem  PropertiesUMacrosmynyVBA myny  !"#$%&()*+,-./0123456789:;<=>?  0* pHdProjectQ(@= l ^ J< rstdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\Windows\SysWOW64\e2.tlb#OLE Automation`ENormalENCrmaQF  * \C Iݪ^!OfficgOficg!G{2DF8D04C-5BFA-101@B-BDE5gAjAedir ThisDocument _VBA_PROJECT'` PROJECT U42ggram Files (x86)\@Common \Microsoft Shared\OFFICE14\MSO.DL L#P 14.0 Ob Li`brary'zMSF@Cs>MSFDHs3@eD452EE1-E08F1A-8-02608C4 D0BB4eINDOWSeFM260L'B @r&/;"1ă} AÃ00}#0ƒ# 0@1928E157-56]42D@2-9FE2cC12978B96 `Users\mbresna1\AppData\Local\Temp\Word8 .0[B0.exd\U5@#.E .`PM DBThisDocum@entGTAisDecDu@en 2 ` Hբ1"v",""+xME (S"SS"<(1Normal.ThisDocument8(%HxAttribute VB_Name = "ThisDocument" Bas1Normal.VGlobal!SpaclFalse CreatablPre declaIdTru BExposeTemplateDeriv$Custom izC1a  *\G{000204EF-0000-0000-C000-000000000046}#4.1#9#C:\PROGRA~2\COMMON~1\MICROS~1\VBA\VBA7\VBE7.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.5#0#C:\Program Files (x86)\Microsoft Office\Office14\MSWORD.OLB#Microsoft Word 14.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\Windows\SysWOW64\stdole2.tlb#OLE Automation*\CNormal*\CNormalIݪ^4*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.5#0#C:\Program Files (x86)\Common Files\Microsoft Shared\OFFICE14\MSO.DLL#Microsoft Office 14.0 Object Library*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\WINDOWS\SysWOW64\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{1928E157-56E5-42D2-9FE2-5BC12978B962}#2.0#0#C:\Users\mbresna1\AppData\Local\Temp\Word8.0\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M  ^ThisDocument0;5833014aThisDocument H]`OǯA(`&WordkVBAWin16~Win32Win64xMacVBA6#VBA7#Project1 stdole`Project- ThisDocument< _EvaluateNormalOfficeuMSFormsCDefaultOcxNameDocumentj`"$& ID="{248E6AA8-BF0D-49A3-9109-1BA1E01EF858}" Document=ThisDocument/&H00000000 Name="Project" HelpContextID="0" VersionCompatible32="393222000" CMG="F0F21AD81ED81ED81ED81E" DPB="E0E20ACD0BCD0BCD" GC="D0D23ABD3BBD3B42" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 &H00000002={000209F2-0000-0000-C000-000000000046};Word8.0;&H00000000 ThisDocumentThisDocument  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qPROJECTwm[)CompObj\r