August 22, 2013

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Dear *,

Please find enclosed copies of the informed consent and/or HIPAA authorization form that your parent/guardian signed in the past. The form(s) allowed you to take part in a Children’s Oncology Group (COG) research study. The form(s) describe all aspects of the research study.

Now that you have reached the age of 18, federal law requires you to decide whether or not to continue to allow your health information to be used for the research. The only remaining piece of the research for you is the ongoing collection of information about you and your health. We would like to collect this information in order to gather data about long-term effects of your cancer treatment on your current health.

If you have questions about any aspect of this research, please contact Bonnie Carpenter at 1‑800‑782‑8581, ext. 9-3639 or 715-389-3639.

⁭	Yes, I am willing to remain in the research study.

Sign both copies of the enclosed 18 Year Old Consent Addendum and/or HIPAA authorization form(s).

Keep one of each for your records.

Return one of each of the forms in the enclosed envelope.

⁭	No, I am not willing to remain in the research study.

Please sign on the following line: ______________________________________

Return this letter in the enclosed envelope.

Thank you for making your decision about our research study.

Sincerely yours,

Bonnie Carpenter, CRC

Pediatric Oncology Research Coordinator

Marshfield Clinic Research Foundation

April 28, 2008

Mary Spindler

2008-05-08

Dux, Barbara J

Marshfield Clinic