Dear Students,

Before starting this assignment, please read the Lecture 8 resource. After you understand the key
features and basic components of informed consent, I want you to prepare a Non-Research Clinical
Practices Informed Consent Form for your patient described below. The information to be provided
should cover all of the following:

a. The current health condition of the patient and the diagnosis made, (9p)
b. The type of the recommended treatment method, (9p)
c. Chance and duration of success, (9p)
d. The risks of the treatment method for the patient's health, (9p)
e. Application of treatment, possible side effects, (9p)
f. The consequences of the disease if the patient does not accept the recommended treatment,
(9p)
g. Possible treatment options and risks. (9p)

The main purpose is to give information to the patient and to make them understand this
information. The patient should be informed in accordance with his own culture and education level.
For this reason, prepare a simple, clear text that everyone can understand and free from medical
terms (12p). Dont forget to write in a statement such as : “I have read all the explanations on the
informed consent form. Written and verbal explanation about the treatment was given to me by the
physiotherapist named below. I understand the risks…….or I agree to…..”. The name / surname /
signature / date. Please contact me for your questions… (10p)

We will be talking about the details of strengthening and active stretching exercises next week. You
have to research more yourself. The important thing for me will be whether the rules of the form are
followed or not. You may not know the details of the disease or the exercises.

• My score for homework that is identical will be zero. Please everyone submit their original
paper. Copied assignments will be ignored.
• The design of the assignment is up to your creativity. You can use MS Word templates,
tables, figures. (5p). The aim is to give the patient the summary and correct information.
• Your homework should be at least 300 words. No extra points will be awarded to those who
write above 400 words. (10p)

Deadline for submission of assignments is December 23th at 9:00. Each day you send it late will
deduct 20% from your score.

Good luck!

HOMEWORK

1 – A 52 years old patient who was diagnosed with osteoarthritis and referred to you due to pain in
the knees, stiffness, loss of muscle strength and walking difficulty. Within the scope of the treatment,
you will have 60 minutes of strengthening and active stretching exercises 3 days a week for 12 weeks.
Prepare the Informed Consent Form suitable for your patient.