GETTING INTO THE RECURRENT ABDOMINAL PAIN STUDY:

INSTRUCTIONS FOR PARENTS

We need to make sure that your child is medically eligible for the study.

There are 3 ways to do this:

• (1) Has your child seen a doctor for abdominal pain in the past two years?

If yes, please ask the physician’s office to send the abdominal pain records to:

Melissa Young

M/S A5950

P.O. Box 5371

Seattle, WA 98105-0371

Fax: 206.987.2721

• (2) Make an appointment for your child to be seen by a gastroenterologist at Children’s Hospital in Seattle. To make an appointment, call the Gastroenterology Clinic at 206.987.2521 and hit option #1 for scheduling. You or your insurance provider will need to pay for this visit.

• (3) See a pediatrician or pediatric gastroenterologist of your choice, and have those records sent to Melissa Young at the address or fax number listed above. Again, you or your insurance provider will need to pay for this visit.

FORMS TO FILL OUT

• Medical Release Form

This is for the physician. By signing this form, you are saying that it is okay to have the medical records released. Refer only to abdominal pain visits within the past two years.

• HIPAA Form

This also goes to Melissa Young at the address listed above. Please sign the last page, and send all pages.