Forms / Questionnaires and QxQ

This page is under construction.

The forms on this page can be organized based on administrative, data collection, or annual follow-up documents. The table is also sortable by Form Title and all of the other headers.

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Form Title V1 V1 QxQ V2 V2 QxQ V3 V3 QxQ V4 V4 QxQ
GOLD 1_GLE/GLS_Questionnaire Form_QxQ. GLE_QXQ.pdf
AFU General Testing Awareness GTE
Health Care - HCE HCS HCE HCE HCS HCE
Heart Failure Diagnosis Form HFD
AFU Hospitalized and Emergency Department Events HOE
Heart Failure Abstraction HTF HTF
INCA 2 ICI - Informant Contact Information ICI_QXQ.pdf
Remote Interview Informed Consent Tracking ICRE_QXQ.pdf
Informed Consent Tracking - ICT ICT ICT ICT
Personal Identifiers - IDE IDS IDE IDE IDS IDE
Minor Adverse Event Form - MAE MAE MAE MAE
Personal Medical History - MHE MHS MHE MHE MHS MHE
Myocardial Infarction Abstraction Form MIF MIF
Endpoints Mortality Physician Review Form MOR
Medication Use - MUE MUS MUE MUE MUS MUE
SOL NAFLD Biospecimen Collection QxQ NBB
INCA 2 NEE - Neurocognitive Assessment Scoring NEE_QXQ.pdf
NIMHD Questionnaire NIMHD_QXQ.pdf
INCA2 OITB – Odor Identification Test Bilingual OITB_QXQ.pdf
AFU Outpatient Self-Reported Conditions OPE
Pregnancy Complication Diagnosis PDF
Pregnancy Complications - PCE PCS PCE
Pubertal Development Assessment - QxQ PDAE_QXQ.pdf
Participant Disability Screen - PDE PDS PDE PDE PDS PDE
Participant Feedback - PFE PFS PFE
Phantom Form - PHT PHT PHT PHT
Pulmonary Diagnosis Form PLD PLD
Participant Safety Screening - PSE PSE PSE
Pulmonary Abstraction Form PUL PUL
Pulse Wave Velocity - Eligibility and Recruitment PWE_QXQ.pdf
Pulse Wave Velocity PWV_QXQ.pdf
Report Tracking - RET RET RET RET
Reproductive and Medical History - RME RMS RME RME RMS RME
Serious Adverse Event Form - SAE SAE SAE SAE
Sitting Blood Pressure - SBP SBP SBP SBP
SGM Stress Experience (SEE) SEE_QXQ.pdf
Socioeconomic / Occupation - SEE SES SEE SEE SES SEE
Six Item Cognitive Screener Bilingual - SIB SIB SIB SIB
SANAR Sleep Questionnaire - English (SLEE) SLEE_QXQ.pdf
Social Support - SSE SSS SSE
Endpoints Stroke Diagnosis Form STD
Chronic Stress - STE STS STE
Endpoints Stroke Abstract Form (STR) STR
Tobacco Use - TBE TBS TBE TBE TBS TBE
Unanticipated Problems - UPR UPR UPR UPR
Endpoints Verification of ICD Codes Form VER
Well-Being - WBE WBS WBE
Study Withdrawal WTD_QXQ.pdf