﻿This Informed Consent Form has two parts:	92	This Informed Assent Form has two parts:
Example of question to elucidate understanding:	97	Examples of question to elucidate understanding:
[x]2) the following applies only to  interviews[x]:	96	[x]2) The following applies only to interviews:
Etc. Do you have any more questions?	89	Etc. Do you have any other questions?
[x]The following applies to focus groups[x]:	88	The following applies to focus groups:
Print Name of Parent or Guardian __________________	77	Signature of Parent of Guardian___________________
[x]Print Name of Researcher[x][x]/person taking the consent_[x]_______________________	96	[x]Print Name of Researcher[x][x]/person taking the assent_[x]_______________________
Signature of Researcher /person taking the assent __________________________	94	Signature of Researcher /person taking the consent__________________________
[Informed Consent form for  ______________ _______]	86	[Informed Consent Form for _________________________________]
Participant's signature ______________________________ Date __________ 	86	Investigator's signature _____________________________ Date __________
