MEDICAL RECORD CONTINUATION SHEET (or either: - 
NIH 2514-1 , Consent to Participate In A Clinical Research Study 
NIH 2514-2, Minor Patient's Assent to Participate In A Clinical Research Study 
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1 . Your physician will notify you promptly of HIV test results. 
2. Your physician and/or the Clinical Center HIV counselor will offer you, and any current and/or 
ongoing sexual partner(s) (spouses are generally considered to be current or ongoing 
sexual partners) or needle-sharing partner(s) you identify, information on the meaning of the 
test results and how to prevent the spread of the infection. 
3. Because the virus may be transmitted in several ways, it is important that you inform sexual 
and/or needle-sharing partner(s) that any, or all, of them may have been exposed to the HIV 
virus and encourage them to be tested. If you request it, staff at the Clinical Center will assist 
you in notifying your partner(s) and arrange counseling for them though an HIV counselor. 
4. The results of your HIV test and/or documentation of the diagnosis of AIDS will become a pari 
of your Clinical Center medical record and, as such, will be protected from unauthorized 
disclosure by the Federal Privacy Act of 1974. In general, access to your medical record will 
be restricted to those health care professionals directly involved in your care or in the 
conduct of ongoing biomedical research, and information is not usually released to other 
third parties without your permission or that of your designated representative. However, i 
there are some particular routine uses of such information of which you should be aware. ) : 
a. If you are unwilling or unable to notify your partner(s), the Clinical Center is ; 
responsible for attempting to contact and inform them of their possible exposure to the 
virus. Reasonable attempts will be made to protect your identity including withholding 
your name when notifying any partner(s) of their possible exposure. Some notification j 
or counseling of current and/or ongoing partners may be carried out through | 
arrangements with, or referral to, local public health agencies. ' ’ 
b. A summary of your care at the Clinical Center will be sent to the physician who , | 
referred you here for treatment. 
c. The Clinical Center may report certain communicable diseases, including AIDS and ' f 
symptomatic HIV disease, to the appropriate State and Federal government agencies. 
If you have any questions regarding the HIV testing or the information provided above, you are 
encouraged to discuss them with your physician and/or a Clinical Center HIV counselor (496- 
8955). 
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Recombinant DNA Research, Volume 19 
