INFORMED CONSENT 
UAB 9405 
March 16, 1994 
PAYMENT FOR RESEARCH-RELATED INJURIES 
The University of Alabama at Birmingham does not have provisions for monetary compensation 
in the event of physical injury resulting from the research, and in the event of such injury, 
medical treatment is provided, but is not provided free of charge. 
COSTS 
The investigational vaccine and its administration and follow-up doctor visits will not be charged 
to me or my insurance company. Special immunologic laboratory studies will also not be 
charged to me or my insurance company. Routine laboratory studies (complete blood counts, 
liver function studies, kidney function studies, blood levels of CEA, pregnancy test, tests for 
hepatitis B or human immune deficiency virus infection, etc.) as well as routine diagnostic 
studies to evaluate for the progression or regression of my disease (CT scans of the abdomen 
and chest x-rays) will be billed to my insurance carrier or will have to be borne by me. My 
physician and his staff will assist me in obtaining maximum third party coverage due me. 
QUESTIONS 
If I have any research-related questions or questions about the research compensation or 
treatment of research-related injuries, the following physicians will be glad to answer them: 
Albert F. LoBuglio, M.D. at (205) 934-5077 or Robert M. Conry, M.D. at (205) 934-5077. Also, 
I may contact the Senior Patient Representative, Ms. Tucker Slaughter, at (205) 934-2273 for 
questions concerning my rights as a research subject. 
AGREEMENT 
I have received a copy of this informed consent. I understand that I am not waiving any of my 
legal rights by signing this consent form. My signature below indicates that I agree to participate 
in this study. 
Signature of Subject 
Date 
Signature of Physician 
Date 
Signature of Witness 
Date 
[420] 
Recombinant DNA Research, Volume 19 
