NOU 23 ’94 15=51 
FROT1 GENZYME B 1 OTHERAP 
TO 913014969839 
PAGE . 029 
SHS Approval Scamp Patient ID Stamp 
Massachusetts General Hospital 
MEDICAL RESEARCH CONSENT FORM, Page 12 
Title of Project: Adenovirus-Mediated Gene Transfer for Cvstic 
Fibrosis: Safety of Single Lobar Administration in the Luna 
Principal Investigator: Allen Laoev. M.D, 
REQUEST FOR MORE INFORMATION 
I understand that I may ask more ..questions about the study at any 
time. Dr. at is 
available to answer my questions or concerns. I understand that I 
will be informed of any significant new findings discovered during 
the course of this study which might influence my continued 
participation . 
If during the study, or later, I wish to discuss my participation 
in or concerns regarding it with a person not directly involved, I 
am aware that the Patient Cc.re Representative (617) 726-3370 is 
available to talk with me. A copy of this consent form will be 
given to me to keep for careful re-reading. 
REFUSAL OR WITHDRAWAL OF PART"CTPATION 
I understand that my participation is voluntary and that I may 
refuse to participate or may withdraw consent and discontinue 
participation in the study at any time without prejudice to my 
present or future care at the Massachusetts General Hospital. I 
realize that withdrawal after virus administration and 
hospitalization is discouraged because careful follov-up is 
necessary for my will being. I also understand that Dr. 
may terminate my participation in 
this study at any time after he/she has explained the reasons for 
doing so and has helped arrange for my continued care by my own 
physician, if this is appropriate. 
INJURY STATEMENT 
In the unlikely event I am injured as a direct result of 
participation in this study, I understand that, if I report the 
injury promptly to Dr. , Massachusetts 
General Hospital will provide free medical treatment to me for 
that injury. 
Recombinant DNA Research, Volume 20 
[589] 
