INFORMED CONSENT ADDENDUM PARTICIPATION IN RESEARCH NAME OF STUDY: UCSF Benioff Children’s Hospital Oakland IRB#: UCSF IRB #: Previously, you signed a consent form to allow you or your child to be in a research study This consent addendum will explain the changes that have been made to the study After you review the changes, if you agree to continue in the study, no further action is required If, after you review the changes, you not want to continue in the study, please contact the study investigator to withdraw: INSERT PI’s NAME, PHONE AND EMAIL THE CHANGES TO THE STUDY ARE: UCSF Benioff Children’s Hospital Oakland has become a part of (affiliated with) the University of California, San Francisco (UCSF) As a result of this affiliation, information has been added to the privacy section of the consent form: • Authorized representatives from the following organizations may review your research data for the purpose of monitoring or managing the conduct of this study: o Representatives of the IRB at UCSF Benioff Children’s Hospital Oakland o Representatives of the University of California Also, the IRB contact information has been updated: • If you wish to ask questions about the study or your rights as a research participant to someone other than the researchers or if you wish to voice any problems or concerns you may have about the study, please call the office of the Institutional Review Board at 415-476-1814 WHAT ARE MY RIGHTS? DO I HAVE TO AGREE TO THE CHANGES? Continuing to be in this study is your choice If you agree to continue and later change your mind, you may stop at any time No matter what your decision is, including if you withdraw, there will be no penalty and no new research data will be collected You nor your child will not lose any medical benefits and the quality of your or your child’s medical care at Children’s Hospital will not be affected Integration Consent Addendum 05-20