In order to receive treatment by Maruyama Vaccine (S. S. M.), the following formalities
are necessary. (These are the formalities to receive treatment "in Japan".)
a) When you wish to obtain Maruyama Vaccine for the first time, please visit
the Research Institute of Vaccine Therapy for Tumors and Infections Diseases, Nippon Medical
School Hospital with "Doctor's letter of consent" (A letter stipulating that the doctor agrees
to make injection of Maruyama Vaccine to the patient) and a "Letter of introduction"("Doctor's brief note about
the condition of the patient").
From the second time, it is possible to arrange mailing of Maruyama Vaccine to the doctor in Japan. Necessary procedure can be made at the time of the first visit.
b) When you receive the vaccine for the 2nd time and after, please obtain clinical progress paper from the doctor, and present it to the Research Institute. The blank progress paper is handed to you at the Research Institute.
c) Formalities to obtain Maruyama Vaccine can be made not only by the patient, but also by the family member or friend. The same procedure stipulated above is applied.
d) Application is accepted on Monday, Tuesday and Thursday from 9:00 am to 11:00 am every week. Application is not received on National Holidays.
e) Maruyama Vaccine supplied by one visit is for 40-days usage. (10 amples of A-type,
and 10 containers of B-type: Injection is to be made every other day. It is OK to receive injections
three times per week; i.e. there is two-day rest once a week. Example: Injections to be made on
Monday, Wednesday and Friday with two-day rest on Saturday and Sunday.)
If you recieve Maruyama Vaccine injection 3 times a week, 20 amples is for 6 weeks and 4 days use.
f) The price for 20 containers is Yen 9,000 plus consumption tax (currently 5%).
If you wish to receive the vaccine by mail, postage is Yen 1,000 to any part of "Japan".
On Monday, Tuesday and Thursday when application is received, members of "Committee
for patients receiving Maruyama Vaccine treatment and their family" are available for consultation
at the Research Institute.
Phone No.: 03-3823-4620
Consultation is made from 9:00 am till 1:00 pm.
To: The Research Institute of Vaccine Therapy for Tumors and Infections Diseases, Nippon Medical
School
Name of hospital (clinic):
Full name of patient:
Address:
Phone No.:
Date of birth:
Name of a disease:
Histological opinion:
I accept to give medication of SSM (A & B type) injection (Maruyama Vaccine) to the
patient with above disease.
I agree to cooperate to the study by reporting the patient's progress
of the disease.
Date:
Address of the hospital (clinic):
Name of the hospital (clinic):
Name of the physician in charge and sign or seal:
Phone No.:
a) "The doctor will accept clinical testing on the patient with Maruyama Vaccine."
b) "How the treatment has been made." (Rough explanation would be acceptable.)
(In this case, the document in the form of the Research Institute of Vaccine Therapy is necessary when you make
request for the second lot (20 amples) of Maruyama Vaccine. It is good to send the completed document to the
Institute by mail.)
The Research Institute of Vaccine Therapy for Tumors and Infections,
Nippon Medical School Hospital
a) Address: 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan 113-8706
b) Phone No. of Nippon Medical School Hospital : 03-3822-2131 extention: 5365
c) Phone No. of the Research Institute of Vaccine Therapy for Tumors and Infections: 03-3821-7153
d) Office hour for receiving application for Maruyama Vaccine: 9:00 am to 11:00 am on Monday,
Tuesday and Thursday (Closed on national holidays)
a) Komagome Station
b) Okachimachi Station
c) Ochanomizu Station