1 
MEDICAL RECORD 
CONTINUATION SHEET for either: 
NIH 2514-1, Consent to Participate In A Clinical Research Study 
NIH 2514-2, Minor Patient’s Assent to Participate In A Clinical Research Study 
i 
STUDY NUMBER: CONTINUATION: page _L2 of JLI pages. 
Permission for Autopsy ji 
As described above, we do not believe that the therapy with AdCFTR or the 
tests you will undergo will lead to adverse effects that will cause your 
death. However, as a participant in an innovative study involving the transfer 
of the normal CFTR gene to the cells lining your airways, it is important that 
you understand that should your death occur while in this study, it is of 
vital importance to potential future patients that your doctors are able to 
determine the precise cause of death. In this context, should you die while 
participating in this study, your doctors will ask your family to give 
permission for a full autopsy. By signing this consent form, you cannot force 
your family to agree to this, but by doing so you are indicating your agree- 
ment that an autopsy be carried out. 
PATIENT IDENTIFICATION 
CONTINUATION SHEET for either: 
[790] 
Recombinant DNA Research, Volume 16 
