Informed Consent (Pagtugot)

TITLE: Social Case Study Report

INTERVIEWER

Michelle Lee S. Sabungan

Caraga State University
Km.7 Ampayon, Butuan City
09482714799
michellelee.sabungan@carsu.edu.ph
Purpose of the Study

As a student enrolled in the Social Work course, and enrolled in SW 114 Social
Work Working with Individuals, Families, and Groups, we must submit a social
case study report on a person who is in a crisis situation. This focus has nothing to
do with the person (client) being interviewed but the only goal is to hone the
capacities and knowledge of the student/interviewer.

Study Procedures (Pamaagi sa Pagtuon)

1. Requesting the client's consent for the proposed interview.

2. Assessing what is appropriate and inappropriate to do and use in an interview.

3. Explaining to the client the purpose of the interview to be conducted and what is
his participation in the study using the consent form.

4. Having the client sign the consent form.

5. Requesting permission to begin the interview

Possible Risk

Although we will try to guard your hidden details, there is a possibility that other
students or incoming Social Work students will be able to read this information
because all completed studies will be recorded in the Social Work department.

You have the right not to answer any or all questions and to opt out at any time.

Confidentiality

For the purpose of this tutorial, all information obtained will remain confidential
(Unless necessary). The researcher shall endeavor to preserve the information
including:
1. Logbook you use in each folder on the client to know who has access to the
folder and information.

2. Concealment of information including other identifiable information about the

participant in a private setting directed by the researcher.

Information about the interviewee/participant will remain confidential except in

cases where the student is legally obligated to report an incident. This incident
includes, but is not limited to abuse incidents and other risks.

Contact Information (Impormasyon sa magkita)

Kung aduna kay pangutana sa bisan unsa na oras mahitungod sa pagtuon,o

nasinatian na lisod na epekto nga resulta sa pagsalmot ani nga pagtuon, mahimo
ka sa pagtawag sa nag-interbyo nga ang numero na detalye anaa sa unang bahin.
Kung naa kay kasayuran mahitungod sa imong katungod isip sumasalmot, o kung
anaay mga isyu o kabalaka mahimo nimong isulti sa estudyante na nakalista ang
pangalan sa ubos.

Student: Michelle Lee S. Sabungan

Contact Number: 09482714799

VOLUNTARY PARTICIPATION

Your participation in this study is voluntary. It is up to you to decide whether or

not you are included in this focus. If your decision is to participate in these
activities, you are asked to sign this consent form. After you sign the consent, you
still have the freedom to leave this focus without affecting your relationship with
the interviewer, if any. If you leave before the information is completed, the
information will be returned or it will be deleted.

CONSENT

I read and understood the information provided and was given the opportunity to
ask questions. I understand that my participation is voluntary and I am free to
leave at any time without giving a reason. I understand that I will provide a copy of
this consent form. I volunteer to agree to participate in this study.

Client’s Signature: _____________________ Date: __________

Student’s signature: ____________________ Date: __________