Exam Forms

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MESA Exam 7 Forms

Participant Questionnaires

COVID-19 History v1 (6/30/2022)

Environmental Exposures (4/5/2022)

Family History v1 (3/18/2022)

Health & Life v2 (9/9/2022)

Medical History v3 (6/24/2022)

Medications v2 (3/8/2022)

Neighborhood Questionnaire Completion v1 (4/1/2022)

Neighborhood Questionnaire v2 (5/6/2022)

Personal History v1 (4/5/2022)

Physical Activity v1 (6/16/2023)

Sleep Questionnaire v2 (11/2/2022)

Exam Procedures

Anthropometry v2 (12/19/2022)

Arterial Stiffness (8/3/2022)

Brain MRI Acquisition (3/25/2022)

Brain MRI Exclusion (3/9/2022)

Brain PET Acquisition v3 FBB JHU (2/7/2023)

Brain PET Acquisition v3 PiB COL WFU (2/7/2023)

Brain PET Exclusion (3/9/2022)

Clinic Reception v3 (12/15/2022)

Cognitive Function Testing Completion v2 (6/21/2022)

Lung CT Flash Somantom (9/7/2022)

Lung CT Force (9/7/2022)

Participant Tracking v1 (6/22/2022)

Seated Blood Pressure v2 (12/30/2022)

Short Physical Performance Battery v2 (2/8/2023)

Spirometry (3/23/2022)

UBACC Capacity to Consent v1 (3/18/2022)

UDS Physical Exam (11/12/2021)

Home Monitoring Forms

24H Blood Pressure Monitor v2 (12/21/2022)

Continuous Glucose Monitor v2 (12/21/2022)

Daily Stress Survey (1/10/2022)

Hip and Wrist Activity Monitors (1/4/2022)

Participant Diary v5 (7/28/2022)

Sleep PSG Tracking (3/21/2022)

Sleep Study PSG Questionnaire v3 (11/2/2022)

Stress Reactivity Monitoring v3 (3/1/2023)

Reading Center and Alerts

ABPM Quality Summary v1 (3/21/2022)

Actigraphy Quality Summary v1 (5/2/2022)

Brain MRI Alert Letter Template (11/4/2022)

Brain MRI Alerts v1 (3/25/2022)

CardeaSolo Heart Monitor Alert Letter Template (11/4/2022)

Heart Monitor Alerts (4/15/2022)

Lung CT Alert Letter Template (5/31/2023)

Lung CT Alerts v1 (3/25/2022)

Sleep PSG Quality Summary v1 (5/2/2022)

Laboratory Forms

Biosample Collection v2 (6/2/2022)

Biosample Repeat (12/15/2022)

Blind Duplicates Shipping Form (2/23/2022)

Lab Processing Form (2/23/2022)

Lab Supervisor Checklist

Northwestern Lab Processing Form (2/23/2022)

Shipping Form (2/23/2022)

Pilot Exam Forms

Pilot Participant Evaluation Form v1 (3/14/2022)

Pilot Participant Information v2 (3/29/2022)

Additional Forms

Weekly Procedure Times

Translated Materials

Exam 7 Chinese forms

Exam 7 Spanish forms

MESA Exam 6 Forms

Spanish Forms

Exam 6 Home Visit Forms

Exam 6 Plus Forms

Chinese Forms

Exam 6 Home Visit Forms

Exam 6 Plus Forms

Tissue Sodium

Tissue Sodium MRI Tracking

MESA PET

MRI Exclusion PET

Lung/Lung Non-smoker

Lung Contrast Screener

Lung CT - Alerts

Lung CT Completion - FLASH - Contrast

Lung CT Completion - FLASH - Non-Contrast

Lung CT Completion - Force - Contrast

Lung CT Completion - Force - Non-Contrast

Lung Questionnaire

Spirometry Completion Form

Spirometry Completion Form (QC)

UKNOW

Heart Failure

Echo and Arterial Stiffness Completion

Echo and Arterial Stiffness Completion (QC)

Physical Activity

Six Minute Walk

Atrial Fibrillation

Atrial Fibrillation Study Completion

Brain MRI Completion

Brain MRI Quality Control Form

Brian MRI Scheduling

Digit Symbol CODED

Digit Symbol Coding Table

Sleep and Wake Time Log

ZioPatch Patient Instructions

ZioPatch Start Guide

Core Exam Forms

Carotid Ultrasound

Clinic Reception

Medical History

Personal History

Phlebotomy (6A) - Columbia

Phlebotomy (6A) - Johns Hopkins

Phlebotomy (6A) - Northwestern

Phlebotomy (6A) - Wake Forest

Phlebotomy (6Plus) - Columbia

Phlebotomy (6Plus) - Johns Hopkins

Phlebotomy (6Plus) - Northwestern

Phlebotomy (6Plus) - Wake Forest

Phlebotomy - Columbia

Phlebotomy - Johns Hopkins

Phlebotomy - Northwestern

Phlebotomy - UCLA

Phlebotomy - University of Minnesota

Phlebotomy - Wake Forest

PROMIS Physical Function

MESA INVITE

MESA INVITE 6A and 6 Plus Shipping Form

MESA INVITE Blind Duplicate Shipping Form

MESA INVITE Lab Processing Form

MESA INVITE Phone Screener

MESA INVITE Screener

Participant Materials – FAQs

Participant Materials – Newsletter insert

Participant Materials – Results Letter Template

Participant Materials – Study Information to MESA INVITE Forms list

Participant Materials – Welcome Letter

Phone Script – 2-week phone call

Phone Script – Recruitment

Study Completion Form

Sunlight Exposer Questionnaire

Exam 6 Home Visit Forms

Exam 6 Plus Forms

MESA Exam 5 Forms

Reading Center Data Completion Forms

CT Exam - Cardiac

Retina Completion

Ultrasound Completion

Questionnaire Data Forms

Diet Supplements

Digit Span Test

Digit-Symbol Task

Erectile Dysfunction

Food Frequency Questionnaire

Medical History

Personal History

Clinic Examination Data Forms

Ankle Brachial Index

Clinic Check-off Sheet

Clinic Reception

Phlebotomy Type 1

Phlebotomy Type 2

Phlebotomy Type 3

Phlebotomy Type 4

Phlebotomy Type 5

Phlebotomy Type 6

Resting 12-Lead ECG

Seated Blood Pressure

Ancillary Study Forms

COPD MRI Completion

COPD Questionnaire

Home Information Questionnaire

MESA Spirometry

MESA Stress 2 - English Bundle

MESA Stress 2 - Spanish Bundle

Multilingual Form Bundles

MESA Exam 4 Forms

Ancillary Study Forms

MESA Air Questionnaire

MESA Air Questionnaire Cue Cards

MESA Stress - Health & Life Supplement

MRI Tagging Completion

Spirometry Completion

Spirometry Questionnaire

Spirometry Questionnaire Supplement

Reading Center Data Completion Forms

Questionnaire Data Forms

Medical History

Personal History

Clinic Examination Data Forms

Clinic Check-off Sheet

Clinic Reception

Seated Blood Pressure

MESA Exam 3 Forms

Ancillary Study Forms

Neighborhood Activities

Residential History Questionnaire

Residential History Supplement

Seated Blood Substudy - Dinamap

Seated Blood Substudy - Mercury

Spirometry Completion

Spirometry Questionnaire

Spirometry Questionnaire Supplement

Reading Center Data Completion Forms

CT Exam Completion

Questionnaire Data Forms

Medical History

Personal History

Physical Activity

Clinic Examination Data Forms

Clinic Check-off Sheet

Clinic Reception

Seated Blood Pressure

MESA Exam 2 Forms

Ancillary Study Forms

MRI Tagging Completion

Neighborhood Activities

Residential History Questionnaire

Residential History Supplement

Vision Completion

Reading Center Data Completion Forms

CT Exam Completion

MRI Exam Completion

Spot Urine Collection

Questionnaire Data Forms

Eye Vision History

Medical History

Personal History

Physical Activity

Clinic Examination Data Forms

Clinic Reception

Seated Blood Pressure

MESA Exam 1 Forms

Reading Center Data Collection Forms

Non-Coronary CT Alerts

Reading Center Data Completion Forms

Arterial Pulse Wave

CT Exam Completion

Dietary Intake Cover Sheet

MRI Exam Completion

Resting 12 - Lead ECG

Ultrasound Carotid IMT

Ultrasound Distensibility

Ultrasound Endothelial Function

Urine Collection

Questionnaire Data Forms

Dietary Intake & Nutritional Supplements

Medical History

Clinic Examination Data Forms

Ankle-Arm Blood Pressure

Clinic Check-off Sheet

Clinic Reception

Seated Blood Pressure

Recruitment Forms

Household Enumeration

Non-Participant

Participant Contact