Clinical trial: NCT01287104
Section: Duration of Study Involvement
Subsections: Signature Of Parent(S)/Guardian Date Print Name This Consent Document Has Been Approved For Use From August 21, 2017 Through **August 20, 2018.**

| Signature of Investigator   | Date       | Signature of Witness   | Date   |
|-----------------------------|------------|------------------------|--------|
| Print Name                  | Print Name |                        |        |  
PATIENT IDENTIFICATION CONSENT TO PARTICIPATE IN A CLINICAL RESEARCH
STUDY (Continuation Sheet)
- Adult Patient or - Parent, for Minor Patient NIH-2514-1 (07-09)
P.A.: 09-25-0099 File in Section 4: Protocol Consent