In Case of Emergency Card (ICE) for Subject

March 22, 2018 | Author: Anonymous | Category: Business
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Download In Case of Emergency Card (ICE) for Subject...

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University of Rochester

University of Rochester

Subject Name:

Subject Name:

Research Study Name &/or #:

Research Study Name &/or #:

In Case of Emergency Your safety is very important to us. If you should experience ANY health-related emergency or have questions during the study or within one-month after the study ends, please contact us at the numbers below. Keep this card in your wallet and give a copy to a family member.

In Case of Emergency Your safety is very important to us. If you should experience ANY health-related emergency or have questions during the study or within one-month after the study ends, please contact us at the numbers below. Keep this card in your wallet and give a copy to a family member.

Ray Lyte, MD, PhD – Principal Investigator Harmony Smith, RN – Study Coordinator

Ray Lyte, MD, PhD – Principal Investigator Harmony Smith, RN – Study Coordinator

123-456-7890 (business hours) 999-999-9999 (24 Hours)

123-456-7890 (business hours) 999-999-9999 (24 Hours)

If you receive health care for any reason, please alert the provider that you are participating in a Clinical Research Trial by showing them this card.

If you receive health care for any reason, please alert the provider that you are participating in a Clinical Research Trial by showing them this card.

Contact us immediately, if you have any signs of infection (fever, chills, cough) or develop a rash, headache, nausea, vomiting, confusion, loss of balance, dizziness, difficulty walking or any other concerning symptom. If you require hospitalization, please go to Strong Memorial Hospital.

Contact us immediately, if you have any signs of infection (fever, chills, cough) or develop a rash, headache, nausea, vomiting, confusion, loss of balance, dizziness, difficulty walking or any other concerning symptom. If you require hospitalization, please go to Strong Memorial Hospital.

If you are at another facility, please have your provider call to have you transferred to Strong Hospital by calling: 585.273.4344

If you are at another facility, please have your provider call to have you transferred to Strong Hospital by calling: 585.273.4344

19SEP13

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