{"text":"NHS Confidential: Personal data about a patient \nUNIVERSITY \nVe \n\"GLASGOW \n\u2018Study Number: G\u2018U 4 5 1 \n- . \natient Identification Number for this trial: 571 \n' CONSENT FORM.1 \n|f|g 4of\u2018P\"_roje_ct:v Cardioprotective benefits of fishoils: effects of gender, age and genotype \nName of Research\u00e9r: Dr Muriel J Caslake, Professor Chris J Packard, \n: \u2018Professor William Ferrell : \nPlease Tick box \no : o YES NO \n1 - \"I.confirm that | have read and understand the information sheet dated. 11\/06\/03 \n- (Version 2 ) for the above study and have had the opportunity to ask questions. D \n2. .I.uhd\u00e9}sta\ufb01\u00e9 that my participation is voluntary and that | amfreeto - \ufb01 \u2018 D : \n- withdraw at any time, without giving any reason, without my medical \ncare or legal rights being affected. \n- 3. lunderstand that sections of any of my medical notes may be looked at by responsible d D \nindividuals from.regulatory authorities where. it is relevant to my taking part in research. \n. 1give permission for these individuals to have access to my records. \n[ \n\u2019 4. | consent to being told my apo E genotype result. \n5. | agree to take part in the above study. \nName of Patient Date \/ Sig@ure \nHA!ZQ\u00bb{ NORwood ... .\\Y %\/ 03 ] &)ouum\/\/ \nName of Person taking consent Datel ( Signature [ \n(if different from researcher) \nSignature \nResearcher Date \nLl fozese, 19\/803. \u00a32= \n1 for patient; 1 for researcher; 1 to be kept with hospital notes \nDEPARTMENT OF PATHOLOGICAL BIOCHEMISTRY \n\u2019 Royal Infirmary, Glasgow G4 0SF \n\u2019 Head of Department: Professor J Shepherd - \nDirect Line: 0141-211 4628\/9 or 0141-552 0689 Fax:0141-553 1703 \n\u00a3 mnils Tamae 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