67





 16. For what slud%-relaied purposes will your proteclod health information hb IclleclCd, used .
 and disclosed to olbers?

 Your protected health inrfomation may be collccled, used and disclosed to others to lind out
 )ouc cligibilily for, lo carry o' aani is ievalu.ai1,Is il-resuh of [he rec sarn study. More
 S .' Fticall. your prOLcMLCd health informJltioi nmay bccciL cct used and disclosed fo r he
 following study-relaed purpose(s):

 Sto dclcrminc '1 your selF-illalll i rsncmrnt and spinliual bliefs ad rpJ ninal
 participation arc related to your pain after surgery.


17. Who wll be authllorized o collect, use and distrlse to others orur protected benlll.
 information?

 Your projected health inrbormnion may be collected, used, and disclosed Io otherC by:

 Ihe sluJy Principal Investigalor. Patricia A. McNally
 SDr. Per Gearen, Chainnan, Department of Orthopedics Shnds :i UF
 oljer pro fisionals ai Ihe Uniln rsily of Fori da or Shands Hospital tha! proi; siuJv-
 related irealmeni or pmledures
 The University of Florida Instilutional Review Board


I. Once collected or used, wiso may your proie~tcd health information be disclosed le?

 Your proteled health information may be given to:

 United States and foreign oriimniernal 3agenc js -.FW iac responsible for overseeing
 research, such as the Food and Drug Administralion. lhe D'p rrFmnrlt ofEcallh and
 Human Services, and the Olfice ofrHuman Research Protections
 Government agencies who are responsible for oVers~r ing public hc aih conc rrn i ch ~s
 the Centers for Disease Control and Federal, Stale and local health departments


19. If you ngree to pnrliclpate in Ibis research, how long will your proteetrd health
 information be colleled, used and disclosed?

 Your protected health information will he colleled until the end of ihe srudy, This
 information will be used and disclosed forever sine it will be stored for an indeinile period
 of time in a secure dainbas.


259-20031Revo01,27-04: l'iL,c ?