NOU 23 '94 15=52 
FROH GENZYflE EIOTHERRP 
TO 913014969659 
PPGE . 030 
SHS Approval Stamp Patient ID Stamp 
Massachusetts General Hospital 
MEDICAL RESEARCH CONSENT FORM, Page 12 
Title of Project: Adenovirus-Media ted Gene Transfer for Cvstic 
Fibrosis: Safety of Single Lobar Administration in the Lung 
Principal Investigator: Allen Lapev . M.D. 
I have explained to the purpose of 
the research, the procedures required, and the possible risks and 
the discomforts as well as potential benefits to the best of my 
ability . 
Investigator Date 
I confirm that has explained to me the 
purpose of the research, the study procedures that I will undergo 
and the possible risks and discomforts as well as potential 
benefits that I may experience. Alternatives to my participation 
in the study have also been discussed. I have read and I 
understand this consent form. Therefore, I agree to give my 
consent to participate as a subject in this research project. 
Participant 
Date 
witness to Signatures 
Date 
[590] 
Recombinant DNA Research, Volume 20 
