UPCC 3394, June 1994 
5 
University of Pennsylvania 
Informed Consent 
Treatment of advanced CNS malignancy with recombinant adenovirus: Phase IA 
from research procedures, the University will provide medical treatment. Additional 
medical treatment will be provided in accordance with the determination by the 
University of its responsibility to provide such treatment. However, the University does 
not provide compensation to a person who is injured while participating as a subject 
in research. 
1 2) Availability of further information. If you wish further information regarding your rights 
as a research subject, you may contact the Office of Research Administration at the 
University of Pennsylvania by telephoning (215) 898-7293. If significant new knowledge 
is obtained during the course of this research study which may relate to your 
willingness to continue participation, you will be informed of this knowledge. To find 
out more about any aspect of the study including your rights, you may contact the 
investigators. 
13) Voluntary nature of participation. Your participation in this project is voluntary. You 
may refuse to participate in or withdraw from the study at any time without penalty or 
loss of benefits to which you may otherwise be entitled. In case you decide to 
withdraw from the study you may suffer the following consequences. 1) Loss of the 
ability to monitor for side effects of gene therapy. 2) Failure to find out if there are any 
unforeseen risks from gene therapy that may not be obvious without repeated 
evaluation. 
14) Documentation of consent. One copy of this document will be kept together 
with our research records on this study. A second copy will be placed in your hospital 
record. A third copy will be given to you to keep. 
15) Consent of the subject. I have read the information given above. I understand 
the meaning of the information. The investigator has satisfactorily answered my 
questions concerning the study. I hereby consent to participate in the study. I will 
also have my next of kin sign a provisional consent to an autopsy to be used when I 
eventually die. 
16) Names and signatures of consenting person and witnesses. 
Subject's signature 
Witness' signature 
Investigator's signature 
Date 
Date 
Date 
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Recombinant DNA Research, Volume 20 
