General Instructions:

1. A Drug Form 2 should be completed for each drug a participant lists in Section 4, Q.18.B(2).
   
   
2. Notify CAMACS of any frequently used medications that do not have a unique code.
   
   
3. For clinical trials where the participant is blinded to more than 1 medication code as "996."
   
   
4. If the medication is not listed specifically, print the name of the drug in the box at the top right of the page.
   
   
5. If a participant is taking a medication as part of a research study but then continues that mediation after the trial ends during the same visit period, complete two drug forms. One form will correspond to the portion of the visit when the participant was enrolled in the trial. The second drug form will correspond to the portion of the visit continuing the medication usage but not part of the trial.
   
   
   

   Question 1:
   

   If the medication is not being taken as part of a research study, skip "B-F."
   

   Do not answer Q.2-Q.4 if the participant is taking this drug as part of a blinded research study. A blinded study is one in which the participant may have taken a placebo or is unaware of the actual treatment.
   

   In cases where the participant is part of a research study but knows the medication he is taking, complete Q.2 - Q.4
   
   
   

   Question 2:
   

   If the drug was taken for more than 98 times, code as "98." If the participant does not know how many times he took the drug, mark the "Don't Know" bubble and code as "99." RECORD MOST RECENT NUMBER OF TIMES PER [ONE OF THE FOLLOWING] DAY OR WEEK OR MONTH OR YEAR.
   
   
   

   Question 3:
   

   If the participant does not know the length of time he took the drug, mark the "Don't Know" bubble and code as "999."