Office: 313/747-4798 
Clinical Research Center: 313/936-8090 
Voice Mailbox: 313/764-9121 (after office hours) 
Doctor or Nurse: 313/936-6266; Paul Watkins, M.D. 
(This is a hospital beeper; ask the paging 
operator to page #9128. Use the following 
numbers in case of an Emergency Only) . 
(Outside of regular office hours if the paging 
service won't do.) 
Home: 313/995-5848; Dr. Gary J. Nabel 
Questions on my rights as a patient may be directed to Ann Munro in 
the Patient/Staff Relations Office at 313/763-5456. 
I have fully explained to the patient, , 
the nature of the treatment program described above and such risks as are 
involved in its performance. 
Physician's Signature 
I have been fully informed as to the procedures to be followed 
including those which are investigational, and have been given a 
description of the attendant discomforts, risk, and benefits to be 
expected, and the appropriate alternative procedures. I realize that, 
since my participation is voluntary, I can refuse this treatment without 
in any way prejudicing my future medical care. In signing this consent 
form, I agree to this method of treatment, and I understand that I will 
receive the best supportive care even if not receiving this protocol 
treatment. I also understand that my doctors can stop my treatment on 
this protocol if they feel the risks in my case have increased, over time, 
to exceed the potential benefits to me. I understand, also, that if I 
have any questions at any time, they will be answered. I have received a 
copy of this consent form. 
I am not and will not become pregnant during this study. 
I understand that the University will provide first-aid medical 
! treatment in the unlikely event of physical injury resulting from research 
procedures. Treatment of injuries or side effects directly related to the 
experimental treatment will be provided at no cost to me. Additional 
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 
I have [ ] have not [ ] been under the care of a physician within 
! the past twelve (12) months. 
Recombinant DNA Research, Volume 17 
[743] 
