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Forms

Here you can find forms that are in their final version and have been or are about to be put to use in the field. Many of these forms can also be found in the Public Documents section.



Date
View
Audiometry Examination - AUD
02/18/2008
 
Otoscopy - OTO
02/18/2008
 
Tympanometry - TYM
02/18/2008
 


Date
View
ADMINISTRATIVE - Alternate Respondent Information - ARE
03/29/2011
 
ADMINISTRATIVE - Alternate Respondent Information - QxQ
04/12/2011
 
ADMINISTRATIVE - Death Certificate Form - DTH
05/26/2010
 
ADMINISTRATIVE - Death Certificate Form QxQ
08/05/2010
 
Annual Follow-up QxQ
03/17/2009
 
Annual Follow-up Tracking form - AFT
04/23/2009
 
Annual Follow-up Tracking form QxQs
04/23/2009
 
Annual Follow-up Tracking form-verB QxQs-AFTB
04/23/2013
 
Annual Follow-up Tracking form-verB-AFTB
01/08/2013
 
Annual Follow-up Year 1 - AFE
02/06/2012
 
Annual Follow-up Year 1_Spanish - AFS
02/06/2012
 
Annual Follow-up Year 2 - FE2
02/06/2012
 
Annual Follow-up Year 2 - QxQs
02/26/2010
 
Annual Follow-up Year 2_Spanish - FS2
02/06/2012
 
Annual Follow-up Year 3 - FE3
02/19/2013
 
Annual Follow-up Year 3 - FS3
02/19/2013
 
Annual Follow-up Year 3 - QxQs
07/11/2012
 
Annual Follow-up Year 4 - FE4
02/19/2013
 
Annual Follow-up Year 4 - FS4
02/19/2013
 
Annual Follow-up Year 4 - QxQs
07/11/2012
 
Annual Follow-up Year 5 - FE5
02/19/2013
 
Annual Follow-up Year 5 - FS5
03/15/2013
 
Annual Follow-up Year 5 - QxQs
03/15/2013
 
Annual Follow-up Year 6 - FE6
05/14/2014
 
Annual Follow-up Year 6 - FS6
05/14/2014
 
Exit Interview - EXE
10/08/2009
 
Exit Interview_Spanish - EXS
10/08/2009
 
Food Propensity Qx Ver. B - FPE
02/08/2012
 
Food Propensity Qx Ver. B_Spanish - FPS
02/08/2012
 
Informant Interview - IIE
02/08/2012
 
Informant Interview QxQ
03/17/2009
 
Informant Interview_Spanish - IIS
02/08/2012
 
Physician Qx - PQE
03/17/2009
 


Date
View
Ankle Arm Blood Pressure - ABP
02/18/2008
 
Anthropometry - ANT
02/18/2008
 
Biospeciman Collection Form - BIO
02/18/2008
 
Biospecimen Collection Form QxQ
12/19/2007
 
Clinic Checklist - CHK
09/09/2009
 
Phantom Form - PHT
04/13/2009
 
Report Tracking - RET
04/16/2008
 
Report Tracking QxQ
04/16/2008
 
Sitting Blood Pressure - SBP
02/18/2008
 


Date
View
Personal Identifiers - IDE
10/09/2013
 


Date
View
Address Discrepancy Worksheet
05/23/2008
 
Address Discrepancy Worksheet Instructions
05/23/2008
 
Address Selection Worksheet
05/23/2008
 
Drop Point Selection - DPS
02/18/2008
 
HHID Change Notification Worksheet
03/20/2009
 
Individual Eligiblity - ELE
02/25/2008
 
Individual Eligiblity QxQ
03/04/2008
 
Screen and Roster - HSRA
02/12/2008
 
Screen and Roster - HSRB
03/20/2009
 
Screen and Roster QxQ_HSRA
03/04/2008
 
Screen and Roster QxQ_HSRB
03/20/2009
 
Screening Call Tracking - SCT
02/19/2008
 
Screening Call Tracking QxQ
03/04/2008
 


Date
View
ADMINISTRATIVE - Adverse Event Form - Minor - MAE
07/09/2010
 
ADMINISTRATIVE - Adverse Event Form - Serious - SAE
07/09/2010
 
ADMINISTRATIVE - Certification of Translation
05/20/2009
 
ADMINISTRATIVE - Informed Consent Tracking, version B - ICT
03/18/2008
 
ADMINISTRATIVE - Informed Consent Update, version A - ICU
03/30/2011
 
ADMINISTRATIVE - Participant Safety Screening Form - PSE
01/03/2011
 
ADMINISTRATIVE - Participant Safety Screening Form_Spanish - PSS
01/03/2011
 
Alcohol Use - ALE
02/18/2008
 
Alcohol Use QxQ
03/06/2008
 
Alcohol Use_Spanish - ALS
02/18/2008
 
Claudication - CLE
02/28/2008
 
Claudication QxQ
03/06/2008
 
Claudication_Spanish - CLS
02/28/2008
 
Dietary Behavior - DBE
02/18/2008
 
Dietary Behavior QxQ
03/06/2008
 
Dietary Behavior_Spanish - DBS
02/18/2008
 
Economic - ECE
02/18/2008
 
Economic QxQ
03/06/2008
 
Economic_Spanish - ECS
02/18/2008
 
Health Care Use - HCE
08/12/2010
 
Health Care Use QxQ
03/06/2008
 
Health Care Use_Spanish - HCS
09/01/2010
 
Hearing Exam - HEE
02/18/2008
 
Hearing Exam QxQ
03/06/2008
 
Hearing Exam_Spanish - HES
02/18/2008
 
Hearing History - HHE
02/18/2008
 
Hearing History QxQ
03/06/2008
 
Hearing History_Spanish - HHS
02/18/2008
 
Medical History - MHE
02/18/2008
 
Medical History QxQ
03/06/2008
 
Medical History_Spanish - MHS
02/18/2008
 
Medication Use - MUE
02/18/2008
 
Medication Use QxQ
03/06/2008
 
Medication Use_Spanish - MUS
02/18/2008
 
Neurocognitive Assessment - NEE
03/31/2010
 
Neurocognitive Assessment_Spanish - NES
03/31/2010
 
Neurocognitive Assessment_Template for Scoring DSS
10/17/2007
 
Occupation - OCE
02/18/2008
 
Occupation QxQ
03/06/2008
 
Occupation_Spanish - OCS
02/18/2008
 
Oral Health - OHE
02/18/2008
 
Oral Health QxQ
03/06/2008
 
Oral Health_Spanish - OHS
02/18/2008
 
Personal Identifiers - IDE
02/18/2008
 
Personal Identifiers QxQ
03/06/2008
 
Personal Identifiers_Spanish - IDS
09/25/2007
 
Personal Information - PIE
11/21/2008
 
Personal Information QxQ
03/06/2008
 
Personal Information_Spanish - PIS
11/21/2008
 
Physical Activity - PAE
02/18/2008
 
Physical Activity QxQ
03/06/2008
 
Physical Activity_Spanish - PAS
02/18/2008
 
Respiratory - RSE
02/18/2008
 
Respiratory QxQ
03/06/2008
 
Respiratory_Spanish - RSS
02/18/2008
 
SF12v2 Health Survey - SFE
02/18/2008
 
SF12v2 Health Survey QxQ
03/06/2008
 
SF12v2 Health Survey_Spanish - SFS
02/18/2008
 
Sleep - SLE
02/18/2008
 
Sleep QxQ
03/06/2008
 
Sleep_Spanish - SLS
02/18/2008
 
Social Network Index - SNE
02/18/2008
 
Social Network Index QxQ
03/06/2008
 
Social Network Index_Spanish
02/18/2008
 
Sociocultural - SCE
02/18/2008
 
Sociocultural QxQ
03/06/2008
 
Sociocultural_Spanish - SCS
02/18/2008
 
Tobacco Use - TBE
02/18/2008
 
Tobacco Use QxQ
03/06/2008
 
Tobacco Use_Spanish - TBS
02/18/2008
 
Weight History - WHE
02/18/2008
 
Weight History QxQ
03/06/2008
 
Weight History_Spanish - WHS
02/18/2008
 
Well-Being - WBE
02/18/2008
 
Well-Being QxQ
03/06/2008
 
Well-Being_Spanish - WBS
02/18/2008