KIDNEY TUMOR 
injury. ^^°thIu E p?I^!I?hT OR ° THER P ° OCEDUnE AN0 an£ STHESIA (including such items as failure to obtain the desired resun. dscomfort. 
anesthesia, bleeding, infection 
Alternatives to me proposed operation or other procedure 
STANDARD CHEMOTHERAPY AND RADIOTHERAPY RELATIVELY INEFFECTIVE 
IN TREATMENT OF PRIMARY TUMOR 
iv m instances where a discussion of the above is deemed unwise medical practice, there should Oe documented a statement to this effect below, staling 
the reason for this decision ( fhis space may also be used for explanatory diagrams ) 
Witness's Signature 
Patient's Signature 
JHHIDNO d] EZ] Q] [[^) Q] | | 
Signature of Physician Securing Consent 
The undersigned acknowledges receipt of a copy of the foregoing Informed Consent Supplement for an operation or other procedure mis 
.day of. 
. 19 . 
Witness's Signature 
Recombinant DNA Research, Volume 17 
Patient. Closest Retain* or Legal Guardian s 
