Informed Conset to Paricipae in Research
and Autkhorriaon for Collecion, Use, and
Dicrlosure of Protected Health Itnformamion


IRBiB# 259-2


 University of lorida
 Health Center
 Inslitutional Review Board
 APPROVED FOR USE
 From I J/ o./ Through 7, /^/0


 Yolu ar being asked to take pIt in a research study. This form provides you with information
 about die study and sees your aulhorizalion for the collection, us and dis lI run:r L your
 proteclcd health information necessary for the study. The Principal l i ics;I lc.r ( Lh person in
 charge of this research) era representat ivofthe Principal Lrivemigaior will nlio Jdcs:nbe thi- ijuly
 to you end answer all ofyour questions. Before you decide whether or not to lake par, read the
 inmfonaionn below and ask cqucstrion abCtui an.U lliring )jo dJo njiot understand. Your particIpaliaLo L
 entirely voluntary.


 L. Name or Pn.ariipint ("Study Subject")




 2. TIle of Resenrch Study

 Effects ofSpiritual Beliefs and Involvement and a Posiltve Self-HelLh Assessment in
 Prdliclng Postoperative Analgesic Medication Use in Total Joint Arhroplasty in Ihc Older
 Adult


3. Principal Tn% esaiglor and Telephone Number(s)

 Patricia Anne Mc N.ll)
 352-281-7452


4. Source of Funding or Other Material Support

 University of Florida


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