Data Collection Forms and QxQs

Code Version Title Date Form QxQ
AES 1.0 Adverse Events Form 06/10/2014 PDF icon PDF
AES Adverse Events Form (Previous Version) 10/26/2010 PDF icon PDF
ANT 1.0 Anthropometry Form 10/26/2010 PDF icon PDF PDF icon PDF
BEQ 1.0 Baseline Exacerbation History 11/02/2010 PDF icon PDF PDF icon PDF
BMH 2.0 Baseline Medical History 07/06/2011 PDF icon PDF PDF icon PDF
BIO 2.0 Biospecimen Collection Form 01/25/2011 PDF icon PDF PDF icon PDF
BPF 1.0 Blood Pressure Form 10/26/2010 PDF icon PDF PDF icon PDF
BIS 1.0 Bronchitis Index Scoring 03/02/2012 PDF icon PDF
BIE 1.0 Bronchoscopy Inclusion/Exclusion Form 03/06/2012 PDF icon PDF
BCT 1.0 Bronchoscopy Informed Consent Tracking 12/20/2011 PDF icon PDF
BID 1.0 Bronchoscopy Lab ID Form 08/26/2013 PDF icon PDF
BCW 1.0 Bronchoscopy Specimen Collection Worksheet 02/22/2012 PDF icon PDF
BPW 3.0 Bronchoscopy Specimen Collection Worksheet 06/10/2014 PDF icon PDF
BSD 1.0 Bronchoscopy Sputum Lab ID Form 08/26/2013 PDF icon PDF
BSW 2.0 Bronchoscopy Sputum Processing Worksheet 03/06/2012 PDF icon PDF
BWF 1.0 Bronchoscopy Substudy Withdrawal 12/20/2011 PDF icon PDF
CAF 1.0 Cancer Abstraction Form 02/16/2015 PDF icon PDF
CBC 1.1 CBC Results Form 02/16/2011 PDF icon PDF
CCL 1.0 Clinical Center Itinerary 10/26/2010 PDF icon PDF PDF icon PDF
CIF 1.0 Contact Information Form 09/21/2011 PDF icon PDF
CEA 1.0 Coordinator Exacerbation Assessment (Wave 1) 05/27/2014 PDF icon PDF
CTA 2.0 CT Image Acquisition and Transmittal Form 02/17/2012 PDF icon PDF PDF icon PDF
DCF 1.0 Death Certificate Form 12/15/2014 PDF icon PDF
DEM 3.0 Demographic Information Form 07/08/2011 PDF icon PDF PDF icon PDF
DMF 1.0 Diabetes Abstraction Form 02/19/2015 PDF icon PDF
ECA 1.0 eCigarette Use Assessment 06/11/2014 PDF icon PDF
EHF 2.1 Employment History Form 05/08/2011 PDF icon PDF PDF icon PDF
EHA 1.0 Employment History Form - Annual Visits 09/21/2011 PDF icon PDF
ETF 1.0 Event Tracking Form 12/15/2014 PDF icon PDF
EAF 1.0 Exacerbation Assessment 05/27/2014 PDF icon PDF
ERF 1.0 Exacerbation Resolution 08/19/2013 PDF icon PDF
FUQ 1.0 Follow-up Questionnaire 11/02/2010 PDF icon PDF
HRA 2.0 Hospital Record Abstraction Form 10/23/2015 PDF icon PDF
HEF 1.0 Hospitalizations and Exacerbations 09/21/2011 PDF icon PDF
IEC 3.0 Inclusion/Exclusion Criteria Form 08/03/2011 PDF icon PDF PDF icon PDF
IFI 1.0 Informant Interview 11/10/2010 PDF icon PDF
ICT 2.0 Informed Consent Tracking 07/26/2011 PDF icon PDF
LAB 1.0 Lab ID Form 10/26/2010 PDF icon PDF PDF icon PDF
MHF 1.0 Medical History Form for Follow-Up 09/21/2011 PDF icon PDF
MRC 1.0 Modified MRC Dyspnea Scale 10/26/2010 PDF icon PDF PDF icon PDF
MCF 1.0 Monthly Contact 06/17/2013 PDF icon PDF
MIF 1.0 Myocardial Infarction Abstraction Form 02/12/2015 PDF icon PDF
PID 2.0 Personal Identifiers Form 11/09/2010 PDF icon PDF PDF icon PDF
PTA 1.0 Phantom Acquisition and Transmittal Form 10/26/2010 PDF icon PDF
PQE 1.0 Physician Questionnaire 01/21/2015 PDF icon PDF
PSQ 1.1 Pittsburgh Sleep Quality Index 07/12/2011 PDF icon PDF PDF icon PDF
PRH 1.0 Pollution and Residential History Form 10/26/2010 PDF icon PDF PDF icon PDF
PFT 1.0 Pulmonary Function Eligibility 10/26/2010 PDF icon PDF PDF icon PDF
RDS 3.0 Respiratory Disease and Smoke Exposure Questionnaire 08/02/2011 PDF icon PDF PDF icon PDF
RDF 1.0 Respiratory Disease and Smoke Exposure Questionnaire for Follow-Up 09/21/2011 PDF icon PDF
RMU 1.0 Respiratory Medication Use Questionnaire 10/26/2010 PDF icon PDF PDF icon PDF
RTF 1.0 Review Tracking Form 01/20/2016 PDF icon PDF
SMW 1.0 Six Minute Walk Test 10/26/2010 PDF icon PDF PDF icon PDF
SDF 1.0 Spirometry Data Form 11/02/2010 PDF icon PDF PDF icon PDF
SPW 2.0 Sputum Processing Worksheet 09/12/2011 PDF icon PDF PDF icon PDF
ISP 1.0 Sputum Worksheet for post albuterol FEV1 < 1 liter 10/26/2010 PDF icon PDF PDF icon PDF
ISW 1.1 Sputum Worksheet for post albuterol FEV1 > 1 liter 09/19/2011 PDF icon PDF PDF icon PDF
STR 1.0 Stroke Abstraction Form 06/25/2015 PDF icon PDF
RSW 1.0 Study Withdrawal Form 10/20/2010 PDF icon PDF PDF icon PDF
VTD 1.0 Venous Thromboembolic Disease Abstraction Form 02/12/2015 PDF icon PDF
AES XAES PDF icon PDF
ANT XANT PDF icon PDF
BEQ XBEQ PDF icon PDF
BIO XBIO PDF icon PDF
BPF XBPF PDF icon PDF
CAT XCAT PDF icon PDF
CBA XCBA PDF icon PDF
CBC XCBC PDF icon PDF
CIF XCIF PDF icon PDF
CSF XCSF PDF icon PDF
CTF XCTF PDF icon PDF
DEM XDEM PDF icon PDF
ECF XECF PDF icon PDF
EHA XEHA PDF icon PDF
FCT XFCT PDF icon PDF
FUQ XFUQ PDF icon PDF
HDS XHDS PDF icon PDF
HEF XHEF PDF icon PDF
HGS XHGS PDF icon PDF
HIQ XHIQ PDF icon PDF
ISP XISP PDF icon PDF
ISW XISW PDF icon PDF
ITF XITF PDF icon PDF
LAB XLAB PDF icon PDF
MBQ XMBQ PDF icon PDF
MCQ XMCQ PDF icon PDF
MHF XMHF PDF icon PDF
MRC XMRC PDF icon PDF
PFT XPFT PDF icon PDF
PID XPID PDF icon PDF
PRH XPRH PDF icon PDF
PSQ XPSQ PDF icon PDF
RDF XRDF PDF icon PDF
RRM XRRM PDF icon PDF
RSW XRSW PDF icon PDF
SDF XSDF PDF icon PDF
SFS XSFS PDF icon PDF
SGR XSGR PDF icon PDF
SMW XSMW PDF icon PDF
SPB XSPB PDF icon PDF
SPU XSPU PDF icon PDF
SPW XSPW PDF icon PDF
VSA XVSA PDF icon PDF