Proof of Concept - Smart Technology - Lincolnshire

Question 1
I confirm that I have read the information sheet dated 25/11/21 (version 6) for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

Question 2
I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected.

Question 3
I understand that:

• Personal data means data which relates to me and from which I can be identified.
• Pseudonymised data means data where any information that identifies me as an individual is removed or replaced so that my ‘real world’ identity is not revealed.

Question 4
I give permission for the research team to obtain data about me from my GP and Hospital medical record and Secondary User Services (SUS) data and where necessary from NHS digital. This will include social determinants of my health and environmental information.

I understand that this data is pseudonymised where any information that identifies me as an individual is removed or replaced so that my ‘real world’ identity is not revealed to the researchers.

Question 5
I understand that data collected about my health from the Smart Devices and questionnaires used in this study will also be pseudonymised. I consent to this data being stored in Philips HealthSuite where researchers will analyse it.

Question 6
I understand that the data collected cannot be withdrawn and will continue to be used by the NHS as pseudonymised data and by NHS Digital or organisations appointed by the NHS, even after I stop taking part in the study

Question 7
I understand that the personal data I provide on this consent form will be stored by Optima Systems Ltd and used to:

1. Send me the Smart Devices for the study and
2. Contact me regarding the study.

I also understand that only Optima Systems will have access this data during the study.

Question 8
I understand that Optima Systems Ltd is responsible for ensuring that any information that identifies me as an individual is removed or replaced (pseudonymised) so that my ‘real world’ identify is not revealed to the researchers.

Question 9
I understand that Optima Systems Ltd will destroy the personal data they hold on me once the study ends and the final report has been sent to me.

Question 10
I understand that my usual care will not be affected by taking part in the study and that no-one will intervene in my care while I am taking part. I understand that I need to contact NHS 111 or my GP if I feel unwell while I am taking part in the study or call the ambulance service by dialling 999 if I have a serious medical emergency.

Question 11
I agree to my General Practitioner being involved in the study, and for any necessary exchange of information about me between my GP and the research team.

Question 12
I agree to take part in the above study and understand I will not gain any personal benefit from taking part.