Participant in a trial

Participant in a trial

FORM FOR A HEALTHY VOLUNTEER WISHING TO TAKE PART IN A CIC 1417 STUDY

I, the undersigned,
Certify having seen the attached information form on the Healthy volunteers informatized file of the CIC1417.

The collected information is subject to an informatic treatment designed for the wishing-to-participate-in-a-study volunteers file, implying a human person. The data is only destined to the medical and administrative professionals of the CIC 1417. In accordance with the law relative to « information technology and civil liberties » of the 6th of January 1978, modified by the law no 2018-493 of the 20th of June 2018 relative to the protection of personal data. You benefit from the right to access to the data concerning  you and which is processed by the CIC 1417, to demand its correction, its update, its lock or delete and to complete it ; these rights can be applied through the treatment manager (fic.cic.cch@aphp.fr). If the data has not been erased after your demand, you can seize the National Commission for Informatic technology and Civil Liberties (commission coordinates: refer to the CNIL web site).