estimate . 
CONFIDENTIALITY : 
A record of my program while on the study will be kept in a confidential form in 
the Pittsburgh Cancer Institute. During reviews of this data, which are required 
by the Food and Drug Administration as well as the National Cancer Institute, 
access will be provided to my medical records that might reveal my identity. In 
addition, the sponsor of this protocol will have access to my medical records 
that contain information regarding my identify. My medical records may be 
reviewed by qualified members of the Pittsburgh Cancer Institute. Copies of 
information contained in my record, such as laboratory test results, will be made 
for my research record. However, no information by which I can be identified 
will be released or published. 
My signature on the Consent Form indicates my understanding that my research 
records, like hospital records, may be subpoenaed by court order. I consent to 
publication of the results of this study, so long as I am not identifiable by 
name in such publications. 
RIGHT TO WITHDRAW : 
Participation in this study is voluntary. I am free to withdraw my consent to 
participate in this treatment program at any time without prejudice to my 
subsequent care. We would however strongly urge you not to withdraw so that you 
can safely be observed, especially during the period immediately after the 
vaccinations. I realize that I should receive careful medical followup of the 
vaccine sites. If I withdraw from the study I should have other physicians 
involved in my care notified of this treatment. Refusing to participate will 
involve no penalty or loss of benefits. I am free to seek care from a physician 
of my choice at any time. 
COMPENSATION FOR ILLNESS OR INJURY : 
I understand that in the event of physical injury or illness resulting from this 
research procedure no monetary compensation will be made or provision for long 
term medical care. Any immediate emergency medical treatment including 
hospitalization that may be necessary will however be made available to me and 
provided by the University of Pittsburgh Medical Center (UPMO . Payment not 
available through health care coverage will be paid for by the UPMC for acute 
injuries due to the experimental treatment. 
[518] 
Patient's Signature 
Recombinant DNA Research, Volume 16 
