Adult Informed Consent To Participate In A Research Study Page 7
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7CONSENT FORMS:
AFTER reviewing by phone with Marlena, if you are consenting to be part
of the study, please sign and return to the following address by fax or mail:
Marlena S. Fejzo, Ph.D.
675 Charles E. Young Dr. South
5535 MRL Bldg., Slamon Lab
Los Angeles, CA 90095
Fax: (310)825-3761
For cases with HG only: please have your medical records confirming
diagnosis and iv therapy, iv nutrition, or other forms of tube feeding mailed
to the following address:
Marlena S. Fejzo, Ph.D.
675 Charles E. Young Dr. South
5535 MRL Bldg., Slamon Lab
Los Angeles, CA 90095
7
Protocol ID:IRB#11-001681
UCLA IRB Approved Approval Date: 9/15/2014 Through: 9/14/2015 Committee: Medical IRB 1
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