medical treatment will be provided in accordance with the University's 
determination of its responsibility to do so. The University does not, 
however, provide compensation to a person who is injured while 
participating as a subject in research. 
I have not engaged in any other research projects within the past six 
(6) months [ ] . 
Within the past six (6) months, I have been involved in a study by 
Dr. 
I have [ ] have not [ ] been under the care of a physician within 
the past twelve (12) months. 
Signature of Patient 
Date 
Witness 
4/93 
Recombinant DNA Research, Volume 17 
[737] 
