3. I have been told of alternate courses of action in my/my child’s situation. 
4. I understand that the study/treatment proposed may result in risks which are currently 
unforeseeable. 
5. I understand that I may withdraw myself/my child from this study/treatment at any 
time. However, if withdrawal is done after chemotherapy has been given but prior 
to receiving the marrow transplant, this is likely to result in severe, possibly fatal, 
toxicity. 
6. I understand that financial compensation is not provided for participation in this 
study/treatment. 
7. I understand that in the event of physical injury to myself/my child from this 
study/treatment, financial compensation is not available but medical treatment 
necessary will be provided at no direct cost. 
8. I understand that refusal to participate in this study will involve no loss of benefits or 
jeopardize my care at this hospital. 
9. I understand that the information obtained will be kept confidential but that 
supervised review by approved medical representatives of outside institutions or 
agencies may occur. In particular, the chart may be reviewed by an agent of the Food 
and Drug Administration or National Cancer Institute. 
10. I understand that if I have further questions regarding this study/treatment, or 
concern about injury from this study/treatment, I can contact Dr. Victor M. Santana 
or Dr. Malcolm K. Brenner at 901-522-0300. 
11. I understand that further information regarding my/my child’s rights as a research 
participant can be obtained by contacting the Chairman of the Clinical Trials 
Committee at 901-522-0300. 
12. I understand that I shall receive a signed copy of this summary statement. 
Patient 
Parent or Guardian 
Physician 
Witness 
Date 
[734] 
Recombinant DNA Research, Volume 14 
