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I understand that if I have further questions, comments, or concerns about the study or the 
informed consent process, I may write or call the office of the Vice Chancellor-Research 
Programs, 3134 Murphy Hall, UCLA, Los Angeles, CA 90024, (310) 825-8714. 
In signing this consent form, I acknowledge receiving a copy of the form as well as a copy of 
the Subjects’ Bill of Rights. 
Date 
Signature of Patient 
Time 
Signature of Witness 
HSPC #91-10-442 
Date of expiration 
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Recombinant DNA Research, Volume 15 
