PNO 
479 
94? 5S26B 15;49 P.19 
COSTS AND PAYMENTS 
You will not be charged nor will you bo paid for your participation in this study, 
flllhough you will be charged for the (medical and hospital care) you require 
independent of this study just as though you were not part of this study. You will not be 
charged for any research related injury, including ganciclovir treatment if it is required 
COMPENSATION I’OR ILLNESS OR IN.IURY 
You will not be compensated for any ir\juo’ or illness resulting from this study, but 
any emergency medical treatment which may be necessary will be provided. 
CONFIDKMIAl.irY 
Any information about you will be kept in locked files with limited access and not 
di.siiibuied without your permission. Any information about you or your treatment will 
be treated in the same counUeiilial iiiaiiner as other hospital medical records. Tlie 
hospital, the PDA and the National Institute of Health may request to see your records. 
You consent to publication of any information for sclenliric purposes so long as youi 
identity will not be revealed. 
RICH r I Q WU HDRAW 
You may refuse to participate in this study or withdraw any time, and that your 
decision will not adversely affect your care at this hospilal/instilution or cause a loss of 
beiicnis lu which you niiglil otherwise be entitled. You may be withdrawn from the 
study by the investigators if your cells fail to giow adequately in the laboratory, if they 
fail to make enough of the necessary protein or if they become infected or show other 
evidence of being unsuitable for use. 
you INI AH Y C ONSKN^r 
Dr. Herndon has explained all of this to me and has answered all questions 1 
have. I alsu understaiid that any future questions I have about this research will be 
answered by Di. Hcmdoii whu I may call at (412) 687-3900. Any questions I have about 
my rights as a research subject will be answered by the Office of the Senior Vice 
President for Health Sciences at ihc University of Pittsburgh. I3y signing this form, 1 
agree to participate in this study. 
Patient Initials 
[ 446 ] 
Recombinant DNA Research, Volume 19 
