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BASELINE |
PRE-VISIT 9 |
VISIT 9 |
VISIT 10 |
VISIT 11 |
VISIT 12 |
VISIT 13 |
VISIT 14 |
VISIT 15 |
VISIT 16 |
VISIT 17 |
VISIT 18 |
VISIT 19 |
VISIT 20 |
|
FOLLOW-UP
INTERVIEW/EXAM FORMS |
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Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
DRUG1 |
Antiretroviral Medications |
na |
na |
na |
na |
10/1/1998 |
10/1/98 |
4/1/99 |
4/1/1999 |
10/1/1999a |
10/1/1999 |
4/1/2000a |
4/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000a |
10/1/2000a |
10/1/2001 |
10/1/2001 |
10/1/2001a |
10/1/2001a |
10/1/2002a |
10/1/2002 |
4/1/2003 |
4/1/2003 |
4/1/2003a |
4/1/2003a |
4/1/2004 |
4/1/2004 |
|
DRUG2 |
Non-antiviral Medications |
na |
na |
na |
na |
10/1/98 |
10/1/98 |
4/1/99 |
4/1/99 |
4/1/1999a |
4/1/1999a |
4/1/1999b |
4/1/1999b |
10/1/2000a |
10/1/2000 |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000c |
10/1/2000c |
10/1/2003 |
10/1/2003 |
4/1/2004 |
4/1/2004 |
|
DRUG3 |
Hepatitis Medications |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002a |
10/1/2002 |
4/1/2003a |
4/1/2003 |
4/1/2003b |
4/1/2003b |
4/1/2004a |
4/1/2004 |
|
F07 |
Physical Exam |
8/15/1994 |
8/15/1994 |
8/15/1994c |
4/1/1995 |
10/1/1998 |
10/1/1998a |
4/1/1999a |
4/1/1999a |
10/1/1999 |
10/1/1999 |
10/1/1999b |
10/1/1999 |
10/1/1999b |
10/1/1999b |
4/1/2001a |
4/1/2000 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2002 |
10/1/2002a |
4/1/2003 |
4/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003b |
10/1/2003b |
|
F08 |
Gynecological Exam |
8/15/1994 |
8/15/1994 |
4/1/1995d |
4/1/1995 |
10/1/1998 |
10/1/1998 |
4/1/1999a |
4/1/1999a |
10/1/99 |
10/1/1999 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
|
F08a |
Potential CVL Contaminants |
10/15/1995 |
na |
10/15/1995 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
|
F01*/F21 |
Sociodemographics |
8/15/1994c |
8/15/1994 |
4/1/1995 |
4/1/1995 |
10/1/98 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998b |
10/1/1998b |
10/1/1998b |
10/1/1998b |
10/1/1998b |
10/1/1998b |
10/1/1998b |
10/1/1998b |
4/1/2002 |
4/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
|
F02*/F22* |
Medical & Health History |
8/15/1994c |
8/15/1994 |
8/15/1996 |
9/15/1997 |
10/1/1998b |
10/1/1998 |
4/1/1999b |
4/1/1999b |
10/1/1999a |
10/1/1999a |
4/1/2000a |
4/1/2000 |
10/1/2000 |
10/1/2000 |
4/1/2001a |
4/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001b |
10/1/2001b |
na |
na |
na |
na |
na |
na |
na |
na |
|
F22HX |
Follow-up Health History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002a |
10/1/2002 |
4/1/2003a |
4/1/2003 |
10/1/2003a |
10/1/2003 |
4/1/2004 |
4/1/2004 |
|
F22MED |
Medication History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002 |
10/1/2002a |
4/1/2003a |
4/1/2003 |
10/1/2003 |
10/1/2003 |
4/1/2004 |
4/1/2004 |
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F03*/F23 |
OB/GYN History |
10/15/1994 |
8/15/1994 |
3/1/1996 |
8/1/1995 |
10/1/1998a |
10/1/1998 |
10/1/1998c |
10/1/1998c |
10/1/1999 |
10/1/1999 |
4/1/2000 |
4/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000a |
10/1/2000a |
10/1/2000a |
10/1/2000a |
10/1/2002 |
10/1/2002 |
4/1/2003b |
4/1/2003 |
10/1/2003 |
10/1/2003 |
4/1/2004a |
4/1/2004 |
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F23a* |
Fertility and Infertility History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2001a |
4/1/2001a |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F04*/F24 |
Alcohol, Drugs & Sexual Behavior |
8/15/1994c |
8/15/1994 |
6/1/1997 |
6/15/1997 |
10/1/1998a |
10/1/1998 |
4/1/1999 |
4/1/1999 |
10/1/1999a |
10/1/1999a |
4/1/2000a |
4/1/2000a |
4/1/2000a |
4/1/2000a |
4/1/2000a |
4/1/2000a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2002 |
10/1/2002 |
4/1/2003 |
4/1/2003 |
10/1/2003a |
10/1/2003 |
4/1/2004 |
4/1/2004 |
|
F05*/F25 |
Health Care Utilization |
8/15/1994c |
8/15/1994 |
4/1/1995 |
9/15/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
4/1/2004 |
4/1/2004 |
|
F25a* |
Health Care Utilization Supplement |
na |
na |
8/1/1995 |
9/15/1997 |
10/1/1998a |
10/1/1998 |
na |
na |
10/1/1998a |
10/1/1998 |
na |
na |
10/1/1998a |
10/1/1998a |
na |
na |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
na |
na |
na |
na |
na |
na |
na |
na |
|
F06*/F26 |
Psychosocial |
10/15/1994d |
8/15/1994 |
4/1/1995 |
4/1/1995 |
10/1/98 |
10/1/98 |
10/1/1998b |
10/1/1998b |
na |
na |
10/1/1998c |
10/1/1998b |
na |
na |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/1998d |
10/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
|
FHX* |
Family and Personal History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
10/1/2001 |
10/1/2001b |
10/1/2001b |
na |
na |
na |
na |
na |
na |
na |
na |
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*Discontinued |
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SPECIMEN COLLECTION
FORMS |
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Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
F10 |
Plasma & Cell Separation and Freezing |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
8/15/1994 |
|
F09*/F29 |
Blood Specimen Collection Form |
8/15/1994c |
na |
3/1/1996 |
3/1/1996 |
3/1/96 |
3/1/1996 |
3/1/1996 |
3/1/1996 |
3/1/1996a |
3/1/1996 |
4/1/2000 |
4/1/2000 |
10/1/2000 |
10/1/2000 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/1/2001 |
4/2/2004 |
4/2/2004 |
|
F29a |
Antiviral Usage Assessment for Blood
Draw |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/1999a |
10/1/1999 |
10/1/1999b |
10/1/1999b |
10/1/2000 |
10/1/2000 |
10/1/2000a |
10/1/2000a |
10/1/2001 |
10/1/2001 |
10/1/2001a |
10/1/2001 |
10/1/2002 |
10/1/2002 |
4/1/2003 |
4/1/2003 |
4/1/2003a |
4/1/2003a |
4/1/2004 |
4/1/2004 |
|
F11*/F31 |
Specimens Collected During PE |
8/15/1994c |
na |
8/1/1995 |
8/1/1995 |
8/1/1995 |
8/1/1995 |
4/1/1999 |
4/1/1999 |
10/1/1999 |
10/1/1999 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
10/1/2002 |
10/1/2002 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2004 |
4/1/2004 |
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LOCAL LAB FORMS |
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Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
L01 |
HIV ELISA and Western Blot |
8/15/1994 |
na |
8/15/1994 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
|
L02* |
Serum Antibody Tests - Hepatitis |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
8/15/1994 |
na |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L03 |
Automated CBC/Differential |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/94 |
na |
8/15/1994 |
na |
8/15/1994a |
na |
8/15/1994a |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
|
L03a |
Hand-Manual Differential |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
|
L04 |
Flow Cytometry |
8/15/1994 |
na |
8/15/1994 |
na |
10/1/98 |
na |
10/1/1998a |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
|
L05 |
Liver/Renal Function Tests |
8/15/1994c |
na |
8/15/1994c |
na |
8/15/1994c |
na |
na |
na |
8/15/1994c |
na |
na |
na |
8/15/1994c |
na |
8/15/1994c |
na |
8/15/1994c |
na |
4/1/2002 |
na |
10/1/2002 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
L06* |
Serum Antibody Tests - Syphilis
Screening |
8/15/1994c |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
na |
10/1/2001 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L07* |
Mantoux Skin Test Result Anergy Panel |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/94 |
na |
na |
na |
10/1/1999 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L08* |
PPD Skin Test |
1/15/1995 |
na |
1/15/1995 |
na |
1/15/1995 |
na |
na |
na |
10/1/1999 |
na |
na |
na |
10/1/1999 |
na |
na |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
na |
na |
na |
na |
na |
na |
|
L09* |
Chlamydia |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002 |
na |
10/1/2002 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L10* |
Urinalysis |
8/15/1994c |
na |
8/15/1994c |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L11* |
Urine Culture Results |
8/15/1994 |
na |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
8/15/1994 |
na |
8/15/1994 |
na |
na |
na |
na |
na |
|
L12 |
(Urine) Pregnancy Test |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
8/15/1994d |
na |
|
L13* |
Gonorrhea |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002 |
na |
10/1/2002 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L14 |
Colposcopy Results |
9/15/1995 |
9/15/1997 |
9/15/1995 |
9/15/1997 |
9/15/95 |
9/15/1997 |
9/15/1995 |
9/15/1997 |
9/15/1995 |
9/15/1997 |
4/1/2000 |
4/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2002 |
10/1/2002 |
10/1/2002a |
10/1/2002a |
10/1/2002a |
10/1/2002a |
10/1/2002a |
10/1/2002a |
|
L15 |
Biopsy Histopathology Pelvic Exam |
9/15/1995 |
9/15/1997 |
9/15/1995 |
9/15/1997 |
9/15/95 |
9/15/1997 |
4/1/1999a |
4/1/1999 |
4/1/1999a |
4/1/1999 |
4/1/1999a |
4/1/1999 |
4/1/1999a |
4/1/1999 |
4/1/1999a |
4/1/1999 |
4/1/1999a |
4/1/1999 |
4/1/199a |
4/1/1999 |
10/1/2002 |
10/1/2002 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
|
L16 |
Dysplasia Treatment |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
5/1/1995 |
9/15/1997 |
|
L17* |
Herpes Culture of Ulcers and Fissures |
10/15/1994d |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/15/1994d |
na |
10/15/1994d |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
L18 |
Trichomonas Vaginalis Culture
(optional) |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
|
L19 |
CVL Processing |
8/25/1997 |
na |
8/25/1997 |
na |
10/1/98 |
na |
10/1/1998 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
|
*Discontinued |
|
|
|
|
|
|
|
CENTRAL LAB FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
C30* |
Toxoplasma Serology |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
C31* |
Human Retrovirus Testing |
4/1/1995c |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/1995c |
na |
4/1/1995c |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
C45 |
Bacterial Vaginosis Smear Gram Stain |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
|
C50* |
Urine for Chlamydia |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
na |
na |
8/15/1994 |
na |
na |
na |
8/15/1994 |
na |
na |
na |
8/15/1994 |
na |
8/15/1994 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
C52 |
HPV by PCR |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
8/1/1995 |
na |
|
C54 |
Viral Load |
12/16/1996 |
na |
12/16/1996 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
|
C60 |
Pap Smear |
8/15/1994 |
na |
8/15/1994 |
na |
10/1/1998 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/2002 |
na |
4/1/2002 |
na |
4/1/2002 |
na |
4/1/2002 |
na |
4/1/2002 |
na |
|
C60a |
Pap Smear Retrospective Re-Read v1-15 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
C60b |
Pap Smear Retrospective Re-Read
v16 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
C65 |
Syphilis DFA - Genital Ulcers &
Fissure |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
8/15/1994 |
na |
|
C66* |
Serum Antibody Type-Specific Herpes
Serology |
1/6/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
1/6/1997 |
na |
1/6/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
C70 |
Laboratory - Stimulated Saliva
Evaluation |
10/15/1996 |
na |
10/15/1996 |
na |
10/15/96 |
na |
10/15/1996 |
na |
10/15/1996 |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
10/15/1996a |
na |
|
C71 |
Laboratory - Subgingival Plaque |
10/15/1996 |
na |
10/15/1996 |
na |
10/15/1996 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
|
C72 |
Laboratory - Erythematous Candidiasis Smear Results |
na |
na |
na |
na |
na |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
|
*Discontinued |
|
|
|
|
|
|
|
ADMINISTRATIVE FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
ABRV |
Abbreviated Visit |
na |
na |
8/1/1997 |
na |
8/1/97 |
na |
8/1/1997 |
na |
8/1/1997 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001a |
na |
10/1/2001a |
na |
10/1/2001a |
na |
|
ANTHRO |
Anthropometry Training Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002 |
na |
10/1/2002a |
na |
10/1/2002a |
na |
10/1/2002a |
na |
|
DENR |
Disenrollment Form |
na |
na |
6/15/1997 |
11/1/1997 |
10/1/98 |
10/1/98 |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999c |
4/1/1999c |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
4/1/2003 |
10/1/2002 |
4/1/2003 |
10/1/2002 |
4/1/2004 |
4/1/2004 |
|
INT |
Interim Events Form |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/2000 |
na |
10/1/2000a |
na |
10/1/2000a |
na |
10/1/2000a |
na |
10/1/2000b |
na |
10/1/2000b |
na |
10/1/2000b |
na |
10/1/2000b |
na |
|
MVIS |
Missed Visit Form |
na |
na |
8/1/1996 |
8/1/1996c |
10/1/98 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
|
REF |
Referral Checklist |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
10/1/2001 |
na |
4/1/2002 |
na |
4/1/2002 |
na |
4/1/2003 |
na |
10/1/2003 |
na |
10/1/2003 |
na |
|
TRAN |
Transfer Form |
na |
na |
9/1/1995 |
na |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
|
|
|
|
OUTCOMES
ASCERTAINMENT FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
ACS* |
Ascertainment Control Sheet |
na |
na |
na |
na |
na |
10/1/1998 |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999b |
na |
4/1/1999c |
na |
4/1/1999c |
na |
4/1/1999c |
na |
4/1/1999c |
na |
4/1/1999c |
na |
4/1/1999c |
na |
4/1/1999c |
na |
na |
|
ATC |
Ascertainment Tracking Checklist |
8/15/1994c |
9/15/1997 |
2/1/1997 |
9/15/1997 |
10/1/98 |
10/1/98 |
10/1/98 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/98a |
4/1/2004 |
|
CNCR |
Cancer Registry Case Report |
na |
na |
na |
na |
na |
na |
5/20/1999 |
5/20/1999 |
5/20/1999 |
5/20/1999 |
5/20/1999 |
5/20/1999 |
5/20/1999 |
5/20/1999 |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999a |
5/20/1999b |
5/20/1999b |
|
CORE |
Clinical Outcomes Reporting Form |
na |
na |
na |
na |
na |
na |
4/1/1999b |
4/1/1999a |
4/1/1999b |
4/1/1999d |
4/1/1999c |
4/1/1999e |
10/1/2000 |
10/1/2000 |
4/1/2001 |
4/1/2001a |
4/1/2001 |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
|
TB |
TB - Verified Case Report |
na |
na |
na |
na |
na |
na |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
1/12/1999 |
|
*Discontinued |
|
|
|
|
|
|
|
ACSR PROTOCOL FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
ACSR ATC |
ACSR Ascertainment Tracking Checklist |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999a |
na |
4/1/1999b |
na |
4/1/1999b |
na |
4/1/1999b |
na |
|
QCCD |
QC Review of Cancer Diagnoses |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2004 |
4/1/2004 |
|
QCGY |
QC Review of Gynecologic Material |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
|
QCSS |
QC Central Review of Surgical
Specimens |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
|
|
|
|
|
CARDIOVASCULAR
SUBSTUDY FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
CVNOTI |
Participant Notification |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2004a |
4/1/2004a |
|
CV01 |
Carotid Ultrasound Tracking Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2004b |
4/1/2004 |
|
CV29 |
Fasting Blood Specimen Collection Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/2/2004 |
4/2/2004 |
|
|
|
|
|
HHV-8 SUBSTUDY FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
HVDENR |
Disenrollment |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
HVMVIS |
Missed Visit |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
HVNOTI |
Recruitment Outcome Form |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
HVSPEC |
Specimen Collection |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
4/1/1999 |
na |
4/1/1999 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
|
|
|
INTENSIVE PK
SUBSTUDY FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
PK01 |
Eligibility for Intensive PK Stubstudy |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2004 |
na |
|
PKNOTI |
PK: Participant notification |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2004 |
na |
|
PK02 |
PK: Current Antiretroviral medication
use |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003a |
na |
4/1/2003b |
na |
|
PK02a |
PK: Antiretroviral adherence |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003a |
na |
|
PK03 |
PK: Recent illnesses, concurrent meds
& OB/GYN hist |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003a |
na |
4/1/2003a |
na |
4/1/2003a |
na |
|
PK04 |
PK: Recent substance use |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
PK05a |
PK: Weight and
Specimen collection: group A |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003a |
na |
4/1/2003a |
na |
4/1/2003a |
na |
|
PK05b |
PK: Weight and Specimen collection:
group B |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2004 |
na |
|
PK05c |
PK: Weight and Specimen collection:
group C |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003a |
na |
4/1/2003a |
na |
4/1/2004 |
na |
|
PK06 |
PK: Dosing of antiretroviral
medications |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
10/6/2003 |
na |
10/6/2003b |
na |
|
PK07 |
PK: Plasma Separation and Freezing
Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
PK08 |
PK: Dietary Fat Percentage
Questionnaire |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
5/14/2003 |
na |
5/14/2003a |
na |
5/14/2003a |
na |
|
PK-DIET |
PK: Dietary Assessment |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003a |
na |
4/1/2003a |
na |
4/1/2003a |
na |
|
|
|
|
NIDA I/V AND HCU |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
NI01* |
Health Care Utilization Collaborative WIHS/HERS Interview |
na |
na |
11/1/1996c |
11/1/1996c |
10/1/1998 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NI02* |
General Abstraction |
na |
na |
9/15/1997 |
9/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NI03* |
Pneumonia Abstraction |
na |
na |
11/1/1996 |
11/1/1996 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NI04* |
Pneumonia Episode Abstraction |
na |
na |
8/1/1997 |
8/1/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NI05* |
Diarrhea Abstraction |
na |
na |
11/1/1996c |
11/1/1996c |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NVNOTI* |
Participant Notification |
na |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV01* |
Enrollment Interview |
na |
na |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
11/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV02* |
Antiretroviral Drug Use |
na |
na |
11/15/1997 |
11/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV03* |
Specimen Collection |
na |
na |
11/15/1997 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV04* |
Specimen Processing |
na |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV05* |
Flow Cytometry |
na |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
11/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV06* |
RNA Quantification on CVL |
na |
na |
11/15/1997 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
NV07* |
Urine Toxicology |
na |
na |
11/15/1997 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
*Discontinued |
|
|
|
|
|
|
ORAL PROTOCOL FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
OPNOTI |
Oral Protocol Participant Notification (expansion) |
3/1/1995 |
na |
3/1/1995 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
na |
10/1/2001 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
OP01 |
Medical Evaluation |
10/1/1995c |
9/1/1997 |
10/1/1995c |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
4/1/2004 |
10/1/1998a |
|
OP02 |
Research Interview |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
4/1/2003 |
4/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
|
OP03 |
Saliva Sample Collection |
9/1/1996 |
9/1/1997 |
9/1/1996 |
9/1/1997 |
10/1/1998 |
10/1/1998 |
4/1/1999 |
4/1/1999 |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
|
OP04 |
Oral Mucosal Tissue Exam |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
10/1/98 |
10/1/1998 |
10/1/1998a |
10/1/1998a |
10/1/1998a |
10/1/1998a |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000 |
4/1/2000a |
4/1/2000 |
4/1/2000a |
4/1/2000 |
4/1/2000a |
4/1/2000 |
4/1/2000a |
4/1/2000a |
|
OP04a |
Addendum |
3/1/1995 |
na |
3/1/1995 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
|
OP05 |
Smear Results |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
|
OP06 |
Tooth Count & Random Half Mouth |
3/1/1995c |
9/1/1997 |
3/1/1995c |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
|
OP07 |
Plaque Index |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
|
OP08 |
Gingival Banding Score |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
4/1/2003 |
|
OP09 |
Papillary Assessment |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
4/1/2003 |
4/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
|
OP10 |
Subgingival Plaque |
7/1/1997 |
11/1/1997 |
7/1/1997 |
11/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
10/1/1998 |
10/1/1998a |
4/1/2003 |
4/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
|
OP11 |
Coronal Caries |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
|
OP12 |
Root Caries |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
|
OP13 |
Gingival Bleeding |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
|
OP14 |
Loss of Attachment |
3/1/1995 |
9/1/1997 |
3/1/1995 |
9/1/1997 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
10/1/1998 |
3/1/1995 |
4/1/2003 |
3/1/1995 |
4/1/2003 |
3/1/1995 |
4/1/2003 |
|
OP15 |
Dental Prostheses |
3/1/1995c |
9/1/1997 |
3/1/1995c |
9/1/1997 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
10/1/1998 |
|
OP16 |
Oral Referral and F/U |
3/1/1995c |
9/1/1997 |
3/1/1995c |
9/1/1997 |
10/1/1998 |
10/1/1998 |
4/1/1999 |
4/1/1999 |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
4/1/1999a |
|
|
|
|
PREGNANCY PROTOCOL
FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
PRNOTI |
Enrollment |
na |
na |
na |
na |
na |
na |
4/1/1999a |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
|
PR01 |
Pregnancy Form |
na |
na |
na |
na |
na |
na |
4/1/1999a |
4/1/1999a |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999b |
4/1/1999c |
4/1/1999b |
4/1/1999c |
4/1/1999b |
4/1/1999b |
|
PR02 |
Post-partum Form |
na |
na |
na |
na |
na |
na |
4/1/1999a |
4/1/1999a |
4/1/1999c |
4/1/1999b |
4/1/1999d |
4/1/1999c |
4/1/1999d |
4/1/1999c |
4/1/1999d |
4/1/1999c |
4/1/1999d |
4/1/1999c |
4/1/1999d |
4/1/1999c |
4/1/1999d |
4/1/1999c |
4/1/1999d |
4/1/1999d |
10/1/2003 |
10/1/2003 |
10/1/2003 |
10/1/2003 |
|
|
|
|
PROSPECTIVE
METABOLIC SUBSTUDY FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
MSSCR |
MS: Screening form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
MSNOTI |
MS: Participant notification |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003a |
na |
|
MS01 |
MS: Specimen Collection for Metabolic
Study |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
6/13/2003 |
na |
6/13/2003a |
na |
4/2/2004 |
na |
|
MS02 |
MS: Lab test report form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
MS03 |
MS: DXA scan form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
|
|
|
SEX STEROID SUBSTUDY
FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
SSSCR |
SS: Sex steroid screening form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003a |
4/1/2003 |
4/1/2003a |
4/1/2003 |
4/1/2003b |
4/1/2003a |
|
SSNOTI |
SS: Participant notification |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
SS01 |
SS: Sex steroid lab test report form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
10/1/2003 |
na |
10/1/2003 |
na |
|
|
|
|
VRS
SUBSTUDY FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
VRSNOTI* |
VRS Enrollment Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
na |
10/1/2000 |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
na |
10/1/2000 |
na |
na |
na |
|
VRS01 * |
Stage II Eligibility |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
10/1/2000 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
VRS01r* |
VRS Eligibility for VRS Supplement |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
1/1/2002 |
1/1/2002 |
1/1/2002 |
1/1/2002 |
1/1/2002 |
1/1/2002 |
na |
na |
|
VRS03* |
VRS Illnesses and Medications |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
10/1/2002 |
na |
na |
|
VRS04* |
VRS Antiviral Medications |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
1/1/2002c |
1/1/2002c |
10/1/2003 |
10/1/2003 |
na |
na |
|
VRS05* |
VRS Screening to Determine Changes in
HAART Regimen |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
10/1/2000 |
4/1/2001 |
4/1/2001 |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2001a |
4/1/2003 |
4/1/2003 |
4/1/2003a |
10/1/2003 |
na |
na |
|
VRS06* |
VRS Telephone Interview for Medical
Providers |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
10/1/2000 |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
10/1/2000b |
na |
na |
|
VRS06r* |
VRS Telephone Interview for Medical
Providers |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
6/1/2002 |
6/1/2002 |
6/1/2002 |
6/1/2002 |
6/1/2002 |
6/1/2002 |
6/1/2002 |
6/1/2002 |
na |
na |
|
VRS10* |
VRS Plasma Separation and Freezing |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
1/12/2000 |
1/12/2000 |
1/12/2000 |
1/12/2000 |
1/12/2000 |
1/12/2000 |
1/12/2000 |
1/12/2000 |
10/1/2002 |
1/10/2002 |
10/1/2002 |
10/1/2002 |
10/1/2003 |
10/1/2003 |
na |
na |
|
VRS29* |
VRS Blood Specimen Collection Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2000 |
10/1/2002 |
10/1/2002 |
4/1/2003 |
4/1/2003 |
10/1/2003 |
10/1/2003 |
na |
na |
|
*Discontinued |
|
|
|
|
|
EXPANSION FORMS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
EL* |
New Recruit Eligibility Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001a |
10/1/2001 |
10/12001a |
10/1/2001 |
na |
na |
na |
na |
na |
na |
na |
na |
|
F07r* |
Physical Exam Addendum |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
10/1/2001 |
10/1/2001 |
10/1/2001 |
na |
na |
na |
na |
na |
na |
na |
na |
|
F20* |
New
Recruit Baseline History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
10/1/2001 |
4/1/2002 |
4/1/2002 |
na |
na |
na |
na |
na |
na |
na |
na |
|
F20a* |
New Recruit Baseline History:
Addendum |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
1/1/2002 |
1/1/2002 |
1/1/2002 |
1/1/2002 |
na |
na |
na |
na |
na |
na |
na |
na |
|
F22r* |
New
Recruit ART History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2002a |
4/1/2002a |
na |
na |
na |
na |
na |
na |
na |
na |
|
F29r* |
Blood Specimen Collection Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
na |
10/1/2001 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F31r* |
Specimens Collected During PE |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001a |
na |
10/1/2001a |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
RAB* |
Retrospective Medical Record
Abstraction |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001a |
10/1/2001a |
10/1/2001a |
10/1/2001a |
na |
na |
na |
na |
na |
na |
na |
na |
|
RAB App* |
Retrospective Medical Record
Abstraction Appendix |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001a |
na |
10/1/2001a |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
S2* |
New
Recruit Sreening Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001b |
10/1/2001b |
10/1/2001b |
10/1/2001b |
na |
na |
na |
na |
na |
na |
na |
na |
|
*Discontinued |
|
|
|
|
|
SPANISH VERSIONS |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Form# |
Title |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
Form |
QxQ |
|
ABRV |
Abbreviated Visit |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2000 |
na |
4/1/2000 |
na |
4/1/2000 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2001a |
na |
10/1/2001a |
na |
10/1/2001a |
na |
|
CV01 |
Carotid Ultrasound Tracking Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2004b |
na |
|
CV29 |
Fasting Blood Specimen Collection Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/2/2004 |
na |
|
DRUG1 |
Antiretroviral Medications |
na |
na |
na |
na |
10/1/1998a |
na |
4/1/1999 |
na |
10/1/1999 |
na |
4/1/2000a |
na |
10/1/2000 |
na |
10/1/2000a |
na |
10/1/2001 |
na |
10/1/2001a |
na |
10/1/2002a |
na |
4/1/2003 |
na |
4/1/2003a |
na |
4/1/2004 |
na |
|
DRUG2 |
Non-antiviral Medications |
na |
na |
na |
na |
10/1/1998 |
na |
4/1/1999 |
na |
4/1/1999a |
na |
4/1/1999b |
na |
10/1/2000a |
na |
10/1/2000b |
na |
10/1/2000b |
na |
10/1/2000b |
na |
10/1/2000b |
na |
10/1/2000c |
na |
10/1/2003 |
na |
4/1/2004 |
na |
|
DRUG3 |
Hepatitis Medications |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002a |
na |
4/1/2003a |
na |
4/1/2003b |
na |
4/1/2004 |
na |
|
F07 |
Physical Exam |
na |
na |
na |
na |
na |
na |
4/1/1999a |
na |
10/1/1999 |
na |
10/1/1999b |
na |
10/1/1999b |
na |
4/1/2001a |
na |
10/1/2001 |
na |
10/1/2001 |
na |
10/1/2002 |
na |
4/1/2003 |
na |
10/1/2003 |
na |
10/1/2003b |
na |
|
F20* |
New Recruit Baseline History (Spanish) |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
na |
4/1/2002 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F20a* |
New Recruit Baseline History: Addendum
(Spanish) |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
1/1/2002 |
na |
1/1/2002 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F01*/F21 |
Sociodemographics |
8/15/1994c |
na |
4/1/1995 |
na |
10/1/1998 |
na |
10/1/1998a |
na |
10/1/1998b |
na |
10/1/1998c |
na |
10/1/1998c |
na |
10/1/1998c |
na |
10/1/1998c |
na |
4/1/2002 |
na |
10/1/2002 |
na |
10/1/2002 |
na |
10/1/2002 |
na |
10/1/2002 |
na |
|
F02*/F22* |
Medical & Health History |
8/15/1994c |
na |
8/15/1996 |
na |
10/1/1998b |
na |
4/1/1999b |
na |
10/1/1999 |
na |
4/1/2000a |
na |
10/1/2000 |
na |
4/1/2001a |
na |
10/1/2001 |
na |
10/1/2001b |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F22HX |
Follow-up Health History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002a |
na |
4/1/2003a |
na |
10/1/2003 |
na |
4/1/2004 |
na |
|
F22MED |
Medication History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2002 |
na |
4/1/2003a |
na |
10/1/2003 |
na |
4/1/2004 |
na |
|
F22r * |
New
Recruit ART History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2002a |
4/1/2002a |
na |
na |
na |
na |
na |
na |
na |
na |
|
F03*/F23 |
OB/GYN History |
10/15/1994 |
na |
3/1/1996 |
na |
10/1/1998 |
na |
10/1/1998c |
na |
10/1/1999 |
na |
4/1/2000 |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2000a |
na |
10/1/2000a |
na |
10/1/2002 |
na |
4/1/2003a |
na |
10/1/2003 |
na |
4/1/2004 |
na |
|
F23a* |
Fertility and Infertility History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2001a |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F04*/F24 |
Alcohol, Drugs & Sexual Behavior |
8/15/1994c |
na |
6/15/1997 |
na |
10/1/98 |
na |
4/1/1999 |
na |
10/1/1999 |
na |
4/1/2000a |
na |
4/1/2000a |
na |
4/1/2000a |
na |
10/1/2001a |
na |
10/1/2001a |
na |
10/1/2002 |
na |
4/1/2003 |
na |
10/1/2003 |
na |
4/1/2004 |
na |
|
F05*/F25 |
Health Care Utilization |
8/15/1994c |
na |
4/1/1995 |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998a |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/1998b |
na |
10/1/1998b |
na |
4/1/2004 |
na |
|
F25a* |
Health Care Utilization Supplement |
na |
na |
8/1/1995 |
na |
10/1/1998a |
na |
na |
na |
10/1/1998a |
na |
na |
na |
10/1/1998a |
na |
na |
na |
10/1/1998a |
na |
10/1/1998a |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
F06*/F26 |
Psychosocial |
10/15/1994d |
na |
4/1/1995 |
na |
10/1/1998 |
na |
10/1/1998b |
na |
na |
na |
10/1/1998c |
na |
na |
na |
10/1/1998d |
na |
10/1/1998d |
na |
10/1/1998d |
na |
10/1/1998d |
na |
10/1/1998d |
na |
10/1/2003 |
na |
10/1/2003 |
na |
|
F29 |
Blood Specimen Collection Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/2/2004 |
na |
|
F29a |
Antiviral Usage Assessment for Blood
Draw |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/1999 |
na |
10/1/1999b |
na |
10/1/2000 |
na |
10/1/2000 |
na |
10/1/2001 |
na |
10/1/2001a |
na |
10/1/2002 |
na |
4/1/2003 |
na |
4/1/2003a |
na |
4/1/2004 |
na |
|
FHX* |
Family and Personal History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
na |
10/1/2001b |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
INT |
Interim Events Form |
na |
na |
na |
na |
na |
na |
4/1/1999 |
na |
10/1/1999 |
na |
10/1/1999 |
na |
10/1/2000 |
na |
10/1/2000a |
na |
10/1/2000b |
na |
10/1/2000b |
na |
10/1/2000c |
na |
10/1/2000c |
na |
10/1/2000c |
na |
10/1/2000c |
na |
|
MS01 |
MS: Specimen Collection for Metabolic
Study |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
6/13/2003a |
na |
6/13/2003a |
na |
4/2/2004 |
na |
|
NI01* |
NIDA Health Care Utilization Interview |
na |
na |
11/1/1996c |
na |
10/1/1998a |
na |
10/1/98a |
na |
10/1/1998b |
na |
10/1/1998b |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
OP02 |
Oral Interview |
3/1/1995 |
na |
3/1/1995 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/1998 |
na |
10/1/2003 |
na |
10/1/2003 |
na |
|
PK02 |
PK: Current Antiretroviral Medication
Use |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003a |
na |
4/1/2003b |
na |
|
PK02a |
PK: Antiretroviral Adherence |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003a |
na |
|
PK03 |
PK: Recent Illnesses, Concurrent Meds
& OB/GYN History |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003a |
na |
4/1/2003a |
na |
|
PK04 |
PK: Recent Substance Use |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003 |
na |
4/1/2003 |
na |
4/1/2003 |
na |
|
S2* |
New
Recruit Sreening Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
10/1/2001 |
na |
10/1/2001 |
na |
na |
na |
na |
na |
na |
na |
na |
na |
|
SSSCR |
SS: Sex steroid Screening Form |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
na |
4/1/2003a |
na |
4/1/2003 |
na |
4/1/2003b |
na |
|
*Discontinued |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|