Fight Fatty Liver - Consent

Thank you for your interest in the Fight Fatty Liver program. Every program requires some legal paperwork. It only takes 2 or 3 minutes to read over this material and complete the consent to get started on your journey to better health. 

What should I know about this research? 

Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the most common chronic causes of liver disease in the U.S. It’s estimated that about 25% of adults in the U.S. have NAFLD, and many don’t even know it.   

Non-alcoholic steatohepatitis (NASH) is the more severe form of NAFLD. NASH is liver inflammation and damage caused by a buildup of fat in the liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. Because of the damage, the liver doesn’t work as well as it should.  

Who is eligible to participate in this research? 

We are looking for Male or Females adults at least 18 years of age with or at risk of developing NAFLD, NAFL, NASH.  

What happens if I agree to participate? 

You agree to complete a questionnaire and then be contacted by an HTA Health Services (HTA) Patient Navigator to further qualify you for this program. 

Rights Regarding Participation: Your participation is completely voluntary. You may choose to leave the program at any time for any reason. If you have any questions, please call 1-833-632-1588 and speak to a patient navigator. 

Privacy: To consider you for this program, the project staff must collect, use, and share personal information about you, including your health information and information that can identify you. Information will be collected to determine your eligibility.  We take every precaution to protect your identity and ensure your privacy.  

Benefits: Participation in this program may help you improve your health.  

Risks: We do not anticipate any risks to you for participating in this program. 

What information will be collected and shared? 

Full name, date of birth, email, phone number, address, dependent status, clinical condition, race/ethnicity, applied date, accepted date, rejection date, rejection reason, account set up date, enrolled date, account disabled date, Body Mass Index and Medical History. 

With whom will your information be shared? 

Summit Clinical Research, LLC, its Clinical Partners and HTA Health Services, LLC 

For what purpose will your information be shared? 

To provide our clinical partners with the most up to date information on your interest in participating, acceptance, appointment dates and medical history to further prequalify you as a candidate for participation. You do not have to give this permission. If you decide not to give this permission, you will not be contacted by an HTA Patient Navigator. 

By clicking NEXT, you have agreed to the following: 

You have read and understood the information in this document, 

You are willing to share your contact information with Summit Clinical Research, LLC, its Clinical Partners and HTA Health Services, LLC. 

You agree to be contacted by a Patient Navigator. 

If you are eligible and you agree to participate, you agree to allow HTA Health Services, LLC to share identifiable information (see what information will be collected and shared? section above) with Summit Clinical Research, LLC, and its Clinical Research Partners.