RIGHT TO REFUSE OR WITHDRAW 
My participation in this study is entirely voluntary. I may refuse to participate in the 
Study or I may withdraw at any time. The Investigator will provide me with new 
information developed during the course of the Study which may influence my desire to 
continue my participation. If I withdraw, I will not be penalized and I will not lose any 
benefits to which I am entitled. If I decide to end my participation in the Study, I should 
contact the Investigator who will explain the best procedure for me to withdraw. 
CONFIDENTIALITY 
My name will be kept as confidential as possible within the law. Research files will be 
maintained without identifiers (such as names) and separate from my medical record. The 
link will be kept by Dr. Galpin in a locked file. However, auditors from the Food and 
Drug Administration, and from the sponsor, Viagene, Inc. have the right to audit all 
records. 
COMMERCIAL APPLICATION 
Any commercial diagnostic or therapeutic product or process developed as a result 
of the Study shall be solely and exclusively the property of Viagene, Inc. 
QUESTIONS AND PROBLEMS 
has explained this study to me and 
answered all my questions. If I have other questions or research-related problems, I may 
call Dr. Galpin at (818) 344-61 1 1 during normal working hours. For more information 
regarding patient's rights in research studies, I may call The Human Subjects Office at 
(818) 345-2172. 
If I experience a medical emergency, I should call the Investigator at (8 1 8) 344- 
til 1 1 (24 hour number). 
Recombinant DNA Research, Volume 17 
[921] 
