Forms and Form Codebooks

Form Code Form or Data Book Visit 1 Form Visit 1 Data Book Visit 2 Form Visit 2 Data Book Visit 3 Form Visit 3 Data Book Visit 4 Form Visit 4 Data Book Visit 5/NCS Form Visit 5/NCS Codebook Visit 6/NCS Form Visit 6/NCS Codebook Visit 7/NCS Form Visit 7/NCS Codebook
ANT Anthropometry and QxQ PDF icon ANTA PDF icon ANTA PDF icon ANTB PDF icon ANTB PDF icon ANTC PDF icon ANTC04 PDF icon ANTD PDF icon ANTD PDF icon ANT PDF icon ANT PDF icon ANT PDF icon ANT
CNF Cognitive Function PDF icon CNFA PDF icon CNFB04 PDF icon CNFC04
DTI Dietary Intake PDF icon DTIA PDF icon DTIA PDF icon DTIB PDF icon DTIB PDF icon DTIC PDF icon DTIC04
DHS Dental History PDF icon DHSA PDF icon DHSA04
DSR Dental Screening PDF icon DSRA PDF icon DSRA04
FHX Family History PDF icon FHXA PDF icon FHXA
FTR Fasting/Tracking PDF icon FTRA PDF icon FTRA02 PDF icon FTRB PDF icon FTRB02 PDF icon FTRC PDF icon FTRC04_02 PDF icon FTRD PDF icon FTRD04_02
GTA Oral Glucose Tolerance Administration PDF icon GTAA PDF icon GTAA04_02
GTS Oral Glucose Tolerance Screening Version A PDF icon GTSA PDF icon GTSA04
GTS Oral Glucose Tolerance Screening Version B PDF icon GTSB PDF icon GTSB04
HEF Household Enumeration PDF icon HEFA PDF icon HEFDATA
MHX Health/Medical History PDF icon MHXA PDF icon MHXA02 PDF icon HHXB PDF icon HHXB PDF icon HHXC PDF icon HHXC04 PDF icon HHXD PDF icon HHXD04
HMT Hematology PDF icon HMTA PDF icon HMTA PDF icon HMTB PDF icon HMTB
HOM Home Interview PDF icon HOMA PDF icon HOM
HPC Health and Life Profile (Spielberger Trait Anger Scale) PDF icon HPCB PDF icon HPCA PDF icon HPCB PDF icon HPCB04
ICT Informed Consent Tracking (cumulative) and QxQ PDF icon ICTA PDF icon ICTA04 PDF icon ICT
IDN Identification PDF icon IDNA
INF Inflammation Interview PDF icon INFA PDF icon INFA04
VEN Laboratory (venipuncture and urine) PDF icon VENA PDF icon VENA02 PDF icon VENB PDF icon VENB02 PDF icon VENC PDF icon VENC04_02 PDF icon LABB PDF icon LABB04_02
MHQ Medical History PDF icon MHQA PDF icon MHQA04
AMH Personal and Family Medical History PDF icon AMHA PDF icon AMHA02
MPR MRI Procedure PDF icon MPRA PDF icon MPRA04
MSC MRI Screening PDF icon MSCA PDF icon MSCA04
MSR Medication Survey & QxQ PDF icon MSRA PDF icon MSRA PDF icon MSRB PDF icon MSRB PDF icon MSRC PDF icon MSRC04 PDF icon MSRD PDF icon MSRD04 PDF icon MSR PDF icon MSR PDF icon MSR PDF icon MSR
PAQ Physical Ability PDF icon PAQA PDF icon PAQA04 PDF icon PAQ PDF icon PAQ
PHE Physical Examination PDF icon PHEA PDF icon PHEA PDF icon PHEB PDF icon PHEB
PHX Personal History & QxQ PDF icon PHXA PDF icon PHXA04 PDF icon PHXB PDF icon PHXB04 PDF icon PHX PDF icon PHX PDF icon PHX PDF icon PHX
PLA PPL Physical ActivityPL PDF icon PLAA
PLC PPL Clinic Interview PDF icon PLCA
PLP PPL Post-Clinic Interview PDF icon PLPA
REF Report and Referral PDF icon REFA PDF icon REFD
REX Retinal Exam Form and QxQ PDF icon REXA PDF icon REXA04 PDF icon REXB PDF icon REXB04 PDF icon REX PDF icon REX
RHX Reproductive History PDF icon RHXA PDF icon RHXA PDF icon RHXB PDF icon RHXB PDF icon RHXC PDF icon RHXC04
RPA Physical Activities/Respiratory Symptoms PDF icon RPAA PDF icon RPAA02 PDF icon RPAB PDF icon RPAB PDF icon RPAC PDF icon RPAC04
SBP Sitting Blood Pressure & QxQ PDF icon SBPA PDF icon SBPA02 PDF icon SBPB PDF icon SBPB02 PDF icon SBPC PDF icon SBPC04_02 PDF icon SBPD PDF icon SBPD04_02 PDF icon SBP PDF icon SBP PDF icon SBP PDF icon SBP
SES Socioeconomic Status PDF icon SESA PDF icon SESA04
TIA TIA/Stroke PDF icon TIAB PDF icon TIAB03 PDF icon TIAC PDF icon TIAC PDF icon TIAD PDF icon TIAD04 PDF icon TIAE PDF icon TIAE04
TSR TIA/Stroke Summary PDF icon TSRA PDF icon TSRB
UPD Update PDF icon UPDA PDF icon UPDB
VIT Vitamin Survey PDF icon VITA PDF icon VITA03
HPB Health and Life Profile (Maastricht Vital Exhaustion Questionnaire) PDF icon HPBA PDF icon HPBA
HPA Health and Life Profile (Interpersonal Support Evaluation List and Lubben Social Network Scale) PDF icon HPAA PDF icon HPAA
AAT AAA Technologist Data Collection Form & QxQ PDF icon AAT PDF icon AAT
ALC Alcohol Use Form & QxQ PDF icon ALC PDF icon ALC PDF icon ALC PDF icon ALC
AQC Access and Quality of Care Form & QxQ PDF icon AQC PDF icon AQC
BIO Biospecimen Collection Form & QxQ PDF icon BIO PDF icon BIO PDF icon BIO PDF icon BIO
DLC DLCO Management Form & QxQ PDF icon DLC PDF icon DLC
PAC Physical Activity Form & QxQ PDF icon PAC PDF icon PAC PDF icon PAC PDF icon PAC
PEX Physical Exam Form & QxQ PDF icon PEX PDF icon PEX
PFX Physical Function Form & QxQ PDF icon PFX PDF icon PFX PDF icon PFX PDF icon PFX
PWV Pulse Wave Velocity / Ankle-Brachial Index Data Sheet Form & QxQ PDF icon PWV PDF icon PWV
RSE Respiratory Symptoms Form & QxQ PDF icon RSE PDF icon RSE
CIU Contact Information Update Form & QxQ PDF icon CIU
OIT Observation of Interviewing Techniques Checklist Form PDF icon OIT PDF icon OIT PDF icon OIT
PSA Participant Safety Screen Form & QxQ PDF icon PSA PDF icon PSA PDF icon PSA PDF icon PSA
RTS Recruitment Tracking and Scheduling Form & QxQ PDF icon RTS PDF icon RTS PDF icon RTS PDF icon RTS
AAO AAA Over Reader Data Collection Form & QxQ PDF icon AAO PDF icon AAO
ATF Alert Tracking Form & QxQ PDF icon ATF PDF icon ATF
DLR DLCO Reading Center Form PDF icon DLR PDF icon DLR
ECA Echocardiography Alerts Reporting Form PDF icon ECA PDF icon ECA
LSR Lung Sound Reviewer Form PDF icon LSR PDF icon LSR
MAE Minor Adverse Event Form & QxQ PDF icon MAE PDF icon MAE PDF icon MAE PDF icon MAE
PHT Phantom Form & QxQ PDF icon PHT PDF icon PHT PDF icon PHT
PRO Procedure Completion Form & QxQ PDF icon PRO PDF icon PRO
RVF Repeat Visit Form & QxQ PDF icon RVF PDF icon RVF
SAE Serious Adverse Event Form & QxQ PDF icon SAE PDF icon SAE PDF icon SAE
CES CES Depression Form & QxQ PDF icon CES PDF icon CES PDF icon CES PDF icon CES
MEF MRI Exclusion Form and QxQ PDF icon MEF PDF icon MEF
MME Mini-Mental State Exam Form & QxQ PDF icon MME PDF icon MME PDF icon MME PDF icon MME6
NCS Neurocognitive Summary Scores Form & QxQ PDF icon NCS PDF icon NCS PDF icon NCS PDF icon NCS
NSS NSS Stage 2-3 Selection Form & QxQ PDF icon NSS PDF icon NSS
SMF Subjective Memory Form & QxQ PDF icon SMF PDF icon SMF
NTR Neurocognitive Test Repeat Form PDF icon NTR PDF icon NTR
TIC Telephone Interview for Cognitive Status Form and QxQ PDF icon TIC PDF icon TIC
CDI Clinical Dementia Rating - Informant - Form and QxQ PDF icon CDI PDF icon CDI PDF icon CDI PDF icon CDI
CDP Clinical Dementia Rating - Subject - Form and QxQ PDF icon CDP PDF icon CDP PDF icon CDP PDF icon CDP
CDS Clinical Dementia Rating - Summary & QxQ PDF icon CDS PDF icon CDS PDF icon CDS PDF icon CDS
HIS Hachinski Ischemic Scale Form and QxQ PDF icon HIS PDF icon HIS
NHX Neurological History Form and QxQ PDF icon NHX PDF icon NHX PDF icon NHX PDF icon NHX
NFH Neurologic Family History Form and QxQ PDF icon NFH PDF icon NFH
NPI Neuropsychiatric Inventory Questionnaire Form and QxQ PDF icon NPI PDF icon NPI PDF icon NPI PDF icon NPI
RPN Retinal Pathology Notification Form PDF icon RPN PDF icon RPN
UPR Unified Parkinson's Disease Rating Scale Form and QxQ PDF icon UPR PDF icon UPR
PNE Physical and Neurological Exam Form and QxQ PDF icon PNE PDF icon PNE
MRR MRI Report Referral Form PDF icon MRR PDF icon MRR
MRV Vascular MRI Report Referral Form PDF icon MRV PDF icon MRV
MQS MRI Vascular Lab Quality Scores Form PDF icon MQS PDF icon MQS
ATM Alert Tracking - MRI - Form and QxQ PDF icon ATM PDF icon ATM
MRT MRI Repeatability Tracking Form and QxQ PDF icon MRT PDF icon MRT
SRT Stage 2 and 3 Reports Tracking Form and QxQ PDF icon SRT PDF icon SRT
DRD Dementia Rating Interview - Deceased Participant - Form and QxQ PDF icon DRD
DRL Dementia Rating Interview - Living Participant - Form and QxQ PDF icon DRL
AUD AUD Audiology Assessment PDF icon AUD PDF icon AUD
DCF NCS Diagnostic Classification Form PDF icon DCF PDF icon DCF PDF icon DCF PDF icon DCF
ESS ESS Epworth Sleepiness Scale PDF icon ESS PDF icon ESS
HHI HHI Hearing Handicap Inventory for the Elderly PDF icon HHI PDF icon HHI
HNE HNE Self Reporting Hearing and Noise Exposure Form PDF icon HNE PDF icon HNE
RAR RAR Results and Alert Reporting Form PDF icon RAR PDF icon RAR
UPR UPR Unanticipated Problem Form PDF icon UPR PDF icon UPR
TMW TMW Two Minute Walk Form PDF icon TMW PDF icon TMW
SIX Six Item Screener PDF icon SIX PDF icon SIX
SFE Modified Version of SF-12v2 Health Survey PDF icon SFE PDF icon SFE PDF icon SFE PDF icon SFE