3055434975 
DIU. OF HEM/ONC 
F-400 T-119 P-007/00? PUG ^8 ’93 16 
Informed Consent - 3 Podack/Cassileth 
Alternatives 
Alternatives that could be considered in my case indude treatment with chemotherapy that I have 
received in the past, radiation therapy or different combinations of drugs administered for varying 
periods of time. An additional alternative is no further therapy. I understand that my doctor can 
provide detailed information about my disease and the benefits of the various treatments 
available. I have been told that I should feel free to discuss my disease and my prognosis with 
the doctor. 
I understand that my physician will be available to answer any questions that I may have at any 
time concerning this study. In addition I understand that I am free to ask my physician any 
questions concerning this program that I wish to In the future. I should be aware that added costs 
may arise and some of these costs may not be covered by insurance. My doctor will discuss this 
with me. 
Voluntary Participation 
I am aware that my participation in this study is entirely voluntary. No compensation for 
participation will be given to me. I also understand that I am free to withdraw my consent to 
participate in this program at any time without prejudice to my subsequent care. 1 am free to seek 
care from a physician of my choice at any time. If I do not take part in or withdraw from this 
study, I will continue to receive care. In the event that I withdraw from the study I will continue 
to be followed and clinical data will continue to be collected from my medical records. 
Confidentiality 
I understand that a record of my progress while on this study will be kept in a confidential form 
at the University of Miami School of Medicine. The confidentiality of my record will be carefully 
guarded. During any of their required reviews, representatives of the Food and Drug 
Administration (FDA) and the National Cancer Institute (NCI) may have access to my, medical 
records which contain my identity. However, no information by which I can be identified will be 
released or published. 
1 have read all of the above, asked questions, received answers concerning areas I did not 
understand and I willingly give my consent to participate in this program. Upon signing this form, 
I will receive a copy. 
(Patient’s signature) 
(Date) 
(Witness) 
(Date) 
(Physician) 
(Date) 
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Recombinant DNA Research, Volume 18 
