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pdfB.12 Saliva Collection and Transport Form
Parental Mental Health
PMH Saliva Collection and Transport Form
INSTRUCTIONS: This form is to be completed when a PMH Interviewer collects the saliva specimen and
transports it to the study office.
Part A: Administrative
1.
Recruitment Location: ________________________________________________
2.
Interviewer Name:____________________________________________________
Part B: Biospecimen Collection and Transport Data Elements
3.
Date of saliva sample collection:
Time of Saliva sample collection:
|__|__|/|__|__|/|__|
2_ 0 |__|__|
M
M
D
D
Y
Y
Y
Y
|__|__|:|__|__|
H
H
M
M
AM
PM
Fill in Specimen IDs, or place a Specimen ID label in the appropriate box in the section below.
Specimen Type
4. Specimen ID
5. Transport Temperature
______
°C
Saliva
6. Comments about Collection or Transport:
_______________________________________________________________________________
________________________________________________________________________________________
___________________________________________________________________________________
PMH Saliva Collection and Transport Form.V1.08.06.14
File Type | application/pdf |
File Modified | 2014-12-02 |
File Created | 2014-08-06 |