Accessibility issues or difficulties with this website?
Call 919-962-2073 or email hchsadministration@unc.edu.

Visit Forms

Navigating this page:
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.

Form Title Visit 1 English Visit 1 Spanish Visit 1 QxQ Visit 2 English Visit 2 Spanish Visit 2 QxQ Visit 3 English Visit 3 Spanish Visit 3 QxQ Visit 3 Answer Set
Anthropometry Quality Control AQC AQC PDF icon AQC PDF icon AQC
Cognitive Screening SIB SIB PDF icon SIB PDF icon SIB
Informed Consent Video Narrative (script) PDF PDF
Unanticipated Problem Reporting Form UPR UPR PDF icon UPR PDF icon UPR
Ankle Arm Blood Pressure ABP
Acculturation ACE ACS ACE
Alcohol Use ALE ALS ALE ALE ALS ALE
Anthropometry ANT ANT ANT PDF icon ANT PDF icon ANT
Audiometry Examination AUD
Biospecimen Collection Form BIO BIO BIO BIO PDF icon BIO PDF icon BIO
Clinic Checklist CHK CHK CHK CHK PDF icon CHK PDF icon CHK
Claudication CLE CLS CLE
Dietary Behavior DBE DBS DBE
Drop Point Selection DPS
Economic ECE ECS ECE
Eligibility Screening ELE ELE ELE ELE PDF icon ELE PDF icon ELE
Enrollment Tracking ETF ETF PDF icon ETF PDF icon ETF
Family Cohesion FCE FCS FCE
Health Care Use Vers A/1 HCEA HCSA HCE HCS HCE PDF icon HCE PDF icon HCS PDF icon HCE PDF icon HCE AS
Health Care Use Vers B HCEB HCSB HCEB
Hearing Exam HEE HES HEE
Hearing History HHE HHS HHE
Household Screen and Roster Vers A HSRA HSRA
Household Screen and Roster Vers B HSRB HSRB
Informed Consent Template DOCX DOCX
Informed Consent Tracking ICT ICT ICT PDF icon ICT PDF icon ICT
Informed Consent Update ICU
Personal Identifiers IDE IDS IDE IDE IDS IDE PDF icon IDE PDF icon IDS PDF icon IDE PDF icon IDE AS
Minor Adverse Event Form MAE MAE MAE PDF icon MAE PDF icon MAE
Medical History MHE MHS MHE MHE MHS MHE PDF icon MHE PDF icon MHS PDF icon MHE PDF icon MHE AS
Medication Use MUE MUS MUE MUE MUE MUE PDF icon MUE PDF icon MUS PDF icon MUE PDF icon MUE AS
Neurocognitive Assessment NEE NES
Neurocognitive Assessment Template for Scoring DSS NEE
Occupation OCE OCS OCE
Oral Health OHE OHS OHE
Otoscopy OTO
Physical Activity PAE PAS PAE
Pregnancy Complications PCE PCS PCE
Participant Disability Screen PDE PDS PDE PDF icon PDE PDF icon PDS PDF icon PDE
Participant Feedback PFE PFS PFE
Phantom Form PHT PHT PHT PDF icon PHT PDF icon PHT
Personal Information PIE PIS PIE
Participant Safety Screening PSE PSS PSE PDF icon PSE PDF icon PSE
Report Tracking RET RET RET RET PDF icon RET PDF icon RET
Reproductive and Medical History RME RMS RME PDF icon RME PDF icon RMS PDF icon RME PDF icon RME AS
Respiratory RSE RSS RS
Serious Adverse Event Form SAE SAE SAE PDF icon SAE
Sitting Blood Pressure SBP SBP SBP PDF icon SBP PDF icon SBP
Sociocultural SCE SCS SCE
Screening Call Tracking SCT SCT
Socioeconomic Status/Occupation SEE SES SEE PDF icon SEE PDF icon SES PDF icon SEE PDF icon SEE AS
Sleep SLE SLS SLE
Social Network Index SNE SNS SNE
Social Support SSE SSS SSE
Chronic Stress STE STS STE
Tobacco Use TBE TBS TBE TBE TBS TBE PDF icon TBE PDF icon TBS PDF icon TBE PDF icon TBE AS
Tympanometry TYM
Well-Being WBE WBS WBE WBE WBS WBE
Weight History WHE WHS WHE