13b. If you "%ilhdran. can information about you still he used undinr collected?

 If you withdraw from tie study, the Principnl Investigulor would like to continue to keep and
 use the information ilat you complete using Ihe questionnaires, pain scores, pain medicine
 and olher infornaiion obtained from sour iili~al record. If you refuse to let the Principal
 Irn ctigsator corlinuc to keep and use this inf rmniiori, it will not be used.


13e. Can the Principal Investigator withdraw you from this research study?

 You may be withdrawn from hde sludy without your consent for the following reasons:

 You did not qu.ilif) Ho 'c- in the study because you do not meet the study
 requireonentis Ask the Principal Investigator if you would like more infbormalion
 about (his.


14. How will your privacy and the conflidencialir of )our prolected health informnaila be
 protcoed?

 D)la will be 4i.hcl.iLd a-ld nriinlaincJd using conldential codes to protect your identity. Patricia
 McNally, the Pnicipal Investigator, will gather medical daa obtained from your medical
 record. All data and infonnalion ill bI kept ni a lxked ile in WUiL ofITe:c of Patricia McNally,
 the Principal nvcstigator. Patricia McNally will assign all confidential code rnwbers. Access
 to your file will be restricled to the Principal Investigator.

 If you participate in tlis research, your projected health information will be collected, used, and
 disclosed under the iiens specified in sections 15- 24 below.


15. Ifyou agree to parllcipale in hiis research siudy. what protected health information
 nhout you may be collected, used and disclosed to others?

 To determine your eligibility for die study and as part of our panicipr lion n the study, your
 protected health ifornalion tant is obtained from you, from review of your past, cu ren or
 JurLUic hc iJLh rccords, from procedures such as pl.) i-c examinations, x-rays, blood or urine
 tesis or other procedures, from your response to any study trealmenis you receive, from your
 study hisii5 and phone calls. nnd aniy other slud) relat-d hcalih ini m.ilcior. rniy be collected,
 used and disclosed to others More spec icnll., the following infonnalion may be collected
 used, and disclosed to others:

 Complete past medical history a delerin eligiili c rcrineia lisrd in informed
 consent
 SQuestionnaires thai you have comptcled
 SMedical records about yourjoint replacement surgery
 Medical records about pain medication use after surgery
 Medical records aboul pain reported
 Medical records about anesthesia used during surgery


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