Visit 19 Form Versions
Note: The most current versions are in red.
FOLLOW-UP INTERVIEW/EXAM FORMS
Form# Title Versions                  
F07 Physical Exam 08/15/94c 04/01/95 8/1/95 10/1/98 4/1/99a 10/1/99b 4/1/01a 10/1/01 10/1/02 4/1/03  
F07 (cont) Physical Exam 10/1/03                  
F08 Gynecological Exam 8/15/94d 4/1/95d 10/1/98 4/1/99a 10/1/99 04/01/00 4/1/01        
F08a Potential CVL Contaminants 10/15/95 10/1/98                  
F21 Sociodemographics 4/1/95 10/1/98b 4/1/02 10/1/02              
F22* Medical & Health History 04/01/95c 8/1/95 3/1/96 8/15/96 10/1/98b 4/1/99b 10/1/99a 4/1/00a 10/01/00 4/1/01a  
F22* (cont) Medical & Health History 10/1/01b                    
F22HX Medical & Health History 10/1/02a 4/1/03a 10/1/03a            
F22MED Medical & Health History 10/1/02 4/1/03a 10/1/03              
F23 OB/GYN History 04/01/95c 8/1/95 3/1/96 10/1/98c 10/1/99 4/1/00 10/01/00a 10/1/02 4/1/03b 10/01/03  
F23a* Fertility and Infertility History (visit 14 substudy) 04/01/01a                    
F24 Alcohol, Drugs & Sexual Behavior 4/1/95 8/10/95 6/15/97 10/1/98a 4/1/99 10/1/99a 4/1/00a 10/1/01a 10/1/02 04/01/03  
F24 (cont) Alcohol, Drugs & Sexual Behavior 10/1/03a                  
F25 Health Care Utilization 04/01/95c 10/1/98a                  
F25a* Health Care Utilization Supplement 8/1/95 10/1/98a                  
F26 Psychosocial 4/1/95 10/1/98d 10/1/03                
FHX* Family and Personal History 10/1/00 10/1/01b                  
DRUG1 Antiretroviral Medications 10/1/98 4/1/99 10/1/99a 4/1/00a 10/1/00b 10/1/01a 10/1/02a 4/1/03a      
DRUG2 Non-antiviral Medications 10/1/98 4/1/99c 10/1/00c 10/1/03              
DRUG3 Antiviral Medications 10/1/02a 4/1/03b                
*Discontinued
SPECIMEN COLLECTION FORMS
Form# Title Versions                  
F10 Plasma & Cell Separation and Freezing 8/15/94                  
F29 Blood Specimen Collection Form 4/1/95 8/1/95 3/1/96a 4/1/00 10/1/00 4/1/01          
F29a Antiviral Usage Assessment for Blood Draw 10/1/99b 10/1/00a 10/1/01a 10/1/02 4/1/03a          
F31 Specimens Collected During PE 4/1/95 8/1/95 4/1/99 10/1/99 4/1/00 10/1/02 4/1/03      
LOCAL LAB FORMS
Form# Title Versions                  
L01 HIV ELISA and Western Blot 8/15/94 10/1/98                
L02 Serum Antibody Tests - Hepatitis 8/15/94                  
L03 Automated CBC/Differential 8/15/94a 10/1/00                  
L03a Hand-Manual Differential 8/15/94 10/1/00                  
L04 Flow Cytometry 8/15/94 10/15/96 10/1/98b 10/1/00              
L05 Liver/Renal Function Tests 8/15/94c 4/1/02 10/1/02 4/1/03              
L06 Serum Antibody Tests - Syphilis Screening 8/15/94c 10/1/01                  
L08* PPD Skin Test 8/15/94 1/15/95 10/1/99                
L10 Urinalysis 8/15/94                    
L11 Urine Culture Results 8/15/94                    
L12 (Urine) Pregnancy Test 8/15/94d                    
L14 Colposcopy Results 8/15/94c 5/1/95 9/15/95 4/1/00 10/1/00 10/1/02a          
L15 Biopsy Histopathology Pelvic Exam 8/15/94d 5/1/95 9/15/95 4/1/99a 10/1/02 4/1/03          
L16 Dysplasia Treatment 8/15/94 5/1/95                  
L17 Herpes Culture of Ulcers and Fissures 8/15/94 10/15/94                  
L18 Trichomonas Vaginalis Culture 8/15/94                    
L19 CVL Processing 8/1/96 2/15/97 8/25/97 3/14/98 10/1/98a 10/1/99 10/1/01        
*Discontinued
CENTRAL LAB FORMS
Form# Title Versions                  
C31 Human Retrovirus Testing 04/01/95c                  
C45 Bacterial Vaginosis Smear Gram Stain 8/15/94                  
C50 Urine for Chlamydia 8/15/94                  
C52 HPV by PCR 8/1/95                  
C54 Viral Load 12/16/96 10/1/98 4/1/00              
C60 Pap Smear 8/15/94 10/1/98 4/1/99 4/1/02            
C60a Pap Smear Retrospective Re-Read v1-15 4/1/03                  
C60b Pap Smear Retrospective Re-Read v16  4/1/03                  
C65 Syphilis DFA - Genital Ulcers & Fissure 8/15/94                  
C66 Serum Antibody Type-Specific Herpes Serology 1/6/97                  
C70 Laboratory - Stimulated Saliva Evaluation 10/15/96a                    
C71 Laboratory - Subgingival Plaque 10/15/96 4/1/99a                
C72 Laboratory - Erythematous Candidiasis Smear Results 4/1/99a                  
ADMINISTRATIVE FORMS
Form# Title Versions                  
ABRV Abbreviated Visit 07/11/97 8/1/97 4/1/00 10/1/01a              
ANTHRO Anthropometry Training Form 4/1/99 10/01/02a                
DENR Disenrollment Form 9/1/95 8/1/96 6/15/97 10/1/98a 4/1/99c 10/1/00 4/1/03        
INT Interim Events Form 4/1/99 10/1/99 10/1/00b                
MVIS Missed Visit Form 10/1/95 8/1/96 10/1/98a                
REF Referral Checklist 4/1/00 10/01/01 4/1/02 4/1/03              
TRAN Transfer Form 9/1/95 10/1/98 10/1/01a              
OUTCOMES ASCERTAINMENT FORMS
Form# Title Versions                  
ACS Ascertainment Control Sheet (QxQs only) 10/1/98 04/01/99c                
ATC Ascertainment Tracking Checklist 10/1/98a                    
CNCR Cancer Registry Case Report 5/20/99a                  
CORE Clinical Outcomes Reporting Form 10/1/98 11/16/98 4/1/99c 10/1/00 4/1/01a 4/1/03        
TB TB - Verified Case Report 1/12/99                  
 
PREGNANCY PROTOCOL FORMS
Form# Title Versions                  
PRNOTI Enrollment 04/01/99a 10/1/99                
PR01 Pregnancy Form 04/01/99b                  
PR02 Post-partum Form 04/01/99d 10/1/03                
ACSR PROTOCOL FORMS
Form# Title Versions                  
ACSR ATC ACSR Ascertainment Tracking Checklist 04/01/99b                  
QCGY QC Review of Gynecologic Material 10/1/00                  
QCSS QC Central Review of Surgical Specimens 10/1/00                  
ORAL PROTOCOL FORMS
Form# Title Versions                  
OP01 Medical Evaluation 3/1/95 10/01/95c 10/01/98a              
OP02 Research Interview 3/1/95 10/1/98 4/1/03 10/1/03            
OP03 Saliva Sample Collection 3/1/95 9/1/96 10/1/98 04/01/99a            
OP04 Oral Mucosal Tissue Exam 3/1/95 9/1/96 10/01/98a 4/1/00              
OP04a Addendum 3/1/95 10/01/98a                
OP05 Smear Results 3/1/95 10/1/98                
OP06 Tooth Count & Random Half Mouth 03/01/95c 10/1/98                
OP07 Plaque Index 3/1/95 10/1/98                
OP08 Gingival Banding Score 3/1/95 10/1/98 4/1/03              
OP09 Papillary Assessment 3/1/95 10/1/98 4/1/03 10/1/03            
OP10 Subgingival Plaque 3/1/95 7/1/97 10/1/98 4/1/03 10/1/03          
OP11 Coronal Caries 3/1/95                  
OP12 Root Caries 3/1/95                  
OP13 Gingival Bleeding 3/1/95                  
OP14 Loss of Attachment 3/1/95                  
OP15 Dental Prostheses 03/01/95c 10/1/98                
OP16 Oral Referral and F/U 03/01/95c 10/1/98 04/01/99a              
OPNOTI Oral Protocol Participant Notification (expansion) 3/1/95 10/01/01                
NIDA I/V FORMS*
Form# Title Versions                  
NI01 Health Care Utilization Collaborative WIHS/HERS Interview 10/1/98                  
NV01 Enrollment Interview 11/15/97                  
NV03 Specimen Collection 11/15/97 10/1/98                
NV04 Specimen Processing 11/15/97                  
NV05 Flow Cytometry 11/15/97                  
NV07 Urine Toxicology 11/15/97 10/1/98                
NVNOTI Participant Notification 11/15/97                  
*discontinued
HHV-8 SUBSTUDY FORMS
Form# Title Versions                  
HVDENR Disenrollment 4/1/99                  
HVMVIS Missed Visit 4/1/99                  
HVNOTI Recruitment Outcome Form 4/1/99                  
HVSPEC Specimen Collection 4/1/99                  
VISIT 18/19 SUBSTUDIES: PK, SEX STEROID, METABOLIC
Form# Title Versions                  
PK01 Eligibility for Intensive PK Stubstudy 4/1/03                  
PKNOTI PK: Participant notification 4/1/03                  
PK02 PK: Current Antiretroviral medication use 4/1/03a                  
PK02a PK: Antiretroviral adherence 4/1/03                  
PK03 PK: Recent illnesses, concurrent meds & OB/GYN hist 4/1/03a                  
PK04 PK: Recent substance use 4/1/03                  
PK05a PK: Weight and Specimen collection: group A 4/1/03a                  
PK05b PK: Weight and Specimen collection: group B 4/1/03                  
PK05c PK: Weight and Specimen collection: group C 4/1/03a                  
PK06 PK: Dosing of antiretroviral medications 4/1/03a 10/6/03                
PK07 PK: Plasma Separation and Freezing Form 4/1/03                  
PK08 PK: Dietary Fat Percentage Questionnaire 5/14/03a                  
PK-DIET PK: Dietary Assessment 4/1/03a                  
MSSCR MS: Screening form 4/1/03                  
MSNOTI MS: Participant notification 4/1/03                  
MS01 MS: Specimen Collection for Metabolic Study 6/13/03a                  
MS02 MS: Lab test report form 4/1/03                  
MS03 MS: DXA scan form 4/1/03                  
SSNOTI SS: Participant notification 4/1/03                  
SS01 SS: Sex steroid lab test report form 4/1/03 10/1/03                
SSSCR SS: Sex steroid screening form 4/1/03a                  
FOLLOW-UP INTERVIEW/EXAM FORMS (SPANISH)
Form# Title Versions                  
ABRV Abbreviated Visit 4/1/00 10/1/01a                
DRUG1 Antiviral Medications 10/01/98a 04/01/99a 10/1/99 04/01/00a 10/01/00b 10/1/01a 10/1/02a 4/1/03a    
DRUG2 Non-antiviral Medications 10/1/98 04/01/99c 10/01/00c 10/1/03            
DRUG3 Antiviral Medications 10/1/02a 4/1/03b                
F07 Physical Exam 04/01/99a 10/01/99b 04/01/01a 10/01/01 10/1/02 4/1/03 10/1/03      
F21 Sociodemographics 4/1/95 10/01/98c 4/1/02 10/1/02            
F22* Medical & Health History 04/01/95c 8/1/95 3/1/96 8/15/96 10/01/98a 04/01/99b 10/1/99 04/01/00a 10/1/00 04/01/01a
F22* (cont) Medical & Health History 10/1/01b                  
F22HX Medical & Health History 10/1/02a 4/1/03a 10/1/03              
F22MED Medical & Health History 10/1/02 4/1/03a 10/1/03              
F23 OB/GYN History 04/01/95c 8/1/95 3/1/96 10/01/98c 10/1/99 4/1/00 10/1/00a 10/01/02 4/1/03a 10/1/03
F23a* Fertility and Infertility History (visit 14 substudy) 04/01/01a                  
F24 Alcohol, Drugs & Sexual Behavior 4/1/95 8/1/95 6/15/97 10/01/98b 4/1/99 10/1/99 04/01/00a 10/1/01a 10/01/02 4/1/03
F24 (cont.) Alcohol, Drugs & Sexual Behavior (cont.) 10/1/03                  
F25 Health Care Utilization 04/01/95c 10/01/98b                
F25a* Health Care Utilization Supplement 8/1/05 10/01/98a                
F26 Psychosocial 4/1/95 10/01/98d 10/1/03              
F29a Antiviral Usage Assessment for Blood Draw 10/01/99b 10/01/00a 10/1/01a 10/1/02 4/1/03a            
FHX* Family and Personal History 10/01/00 10/1/01 10/01/01a 10/01/01b            
INT Interim Events Form 4/1/99 10/1/99 10/01/00c              
MS01 MS: Specimen Collection for Metabolic Study 4/1/03 6/13/03a                
PK02 PK: Current Antiretroviral medication use 4/1/03a                  
PK02a PK: Antiretroviral adherence 4/1/03                  
PK03 PK: Recent illnesses, concurrent meds & OB/GYN hist 4/1/03a                  
PK04 PK: Recent substance use 4/1/03                  
SSSCR SS: Sex steroid screening form 4/1/03a                  
OP02 Oral Interview 3/1/95 10/1/98 4/1/03 10/1/03            
*Discontinued
EXPANSION FORMS*
Form# Title Versions                  
EL New Recruit Eligibility Form 10/1/01a                  
F07R Physical Exam Addendum 10/01/01                  
F20 New Recruit Baseline History (English) 10/01/01 4/1/02                
F20 New Recruit Baseline History (Spanish) 10/01/01 4/1/02                
F20a New Recruit Baseline History: Addendum (English) 01/01/02                  
F20a New Recruit Baseline History: Addendum (Spanish) 01/01/02                  
F22r  New Recruit ART History (English) 4/1/02a                  
F22r  New Recruit ART History (Spanish) 4/1/02a                  
F29R Blood Specimen Collection Form 10/01/01                  
F31R Specimens Collected During PE 10/1/01a                  
L09 Chlamydia LCR Gen-Probe 8/15/94 10/01/01                
L13 Gonorrhea LCR 8/15/94 10/01/01                
RAB Retrospective Medical Record Abstraction 10/01/01a                  
RAB Appen. Retrospective Medical Record Abstraction Appendix 10/01/01b                  
S2 New Recruit Sreening Form (English) 10/1/01b                  
S2 New Recruit Sreening Form (Spanish) 10/1/01a                  
*discontinued