) MEDICAL RECORD CONTINUATION SHEET for either: - 
NIH 2514-1. Consenlto Pahicipate In A Clinical Research Study 
I NIH 2514-2, Minor Palienfs Assent to Participate In A Clinical Research Study 
I 
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! cminvMiMRm: ~ COfsmNUATIQN: page . . ^ _ d Q pages. 
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^ If you have used drugs or alcohol to excess in the past, or if you are currently using these 
j substances, you must agree to refrain from any further use and may be asked to participate in 
■ regular substance abuse counseling and/or therapy. 
I 
j You may be treated with licensed drugs or drugs available on "expanded access" for HIV-related 
I conditions throughout your participation in this study. You may not take other experimental drugs 
I while participating in this study. 
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I Before participating in this study, you will be asked to appoint a person of your choosing as your 
"Durable Power of Attorney" or DPA. A DPA is a surrogate decision-maker, that is, someone who 
will make medical decisions in your behalf if and only if you become mentally impaired during the 
course of the study. A completed DPA form naming your surrogate decision-maker and signed by 
you will then become part of your medical record at the NIH. 
; NIH AND CLINICAL CENTER POLICIES 
There is no cost to you for the procedures associated with this study, but if you require medical care 
at other institutions or from other physicians during the course of this study, you or your insurance 
company will be charged for this care. Antiviral therapies such as AZT, ddl, ddC, and PCP 
prophylaxis will not be provided by NIH and when indicated, must be prescribed by your personal 
physician. Once your participation in this protocol is completed, you will not be eligible for 
continuing care at NIH, but your doctors at NIH will be glad to provide telephone consultation to 
your home doctor at any time. Letters and results of tests performed at the NIH will be sent to your 
personal physician and you are encouraged to remain in close contact with your doctor. You must 
receive routine medical care from your own physician and you may not rely on the NIH for general 
medical care. 
i NIH AND CLINICAL CENTER HIV POLICY 
Because you are known to be infected with HIV and will have tests performed to confirm this 
I infection for the study, you should be aware of the following Clinical Center policy regarding the 
I diagnosis of AIDS or HIV infection: 
1 . Your physician will notify you promptly of HIV test results. 
I 
I 2. Your physician and/or the Clinical Center HIV counselor will offer you, and any current and/or 
j ongoing sexual partner(s) (spouses are generally considered to be current or ongoing 
I sexual partners) or needle-sharing partner(s) you identify, information on the meaning of the 
j test results and how to prevent the spread of the infection. 
Recombinant DNA Research, Volume 19 
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