and Drug Administration, National Cancer Institute and the sponsor of the 
study, VICAL. 
I understand that in the event of physical injury resulting from this 
research. The University of Chicago Hospitals will provide me with free 
emergency care, if such care is necessary. I also understand that if I wish. 
The University of Chicago Hospitals will provide non-emergency care, but the 
Medical Center assumes no responsibility to pay for such care or to provide 
me with financial compensation. 
I, the undersigned, hereby consent to participate as a subject in the 
above described research project conducted at The University of Chicago 
Hospitals. I have received a copy of this consent form for my records. I 
understand that if I have any questions concerning this research, I can 
contact the doctor(s) listed above. If I have questions concerning my rights 
in connection with the research, I can contact the Institutional Review Board, 
at 312-702-1472. 
After reading the entire consent form, if you have no further questions 
about giving consent, please sign where indicated. 
Doctor: 
Signature of Subject 
Witness: 
Date: 
Signature of Parent or Guardian 
(if patient is a minor) 
Time: am/pm 
I wish to undergo autopsy in the event of my death: Yes No 
(If you answered "Yes" please also inform your next of kin.) 
Revision date: 12/21/93 
Recombinant DNA Research, Volume 19 
[229] 
