Multi-site
Study
Appointment
Reminder Card Flesch-Kincaid
Readability Score – 5.9
Multi-site Study
Appointment Reminder Card
Clinic Visit
Appointment Information
for Your
Multi-site Study Interview
[NAME OF LOCATION]
[Street Address]
[Local or Toll Free
Telephone Number]
Day: |_________________|
Date: |__|__|/|__|__|/|__|__|
Time: |__|__|:|__|__|
□ AM
□
PM
Study ID No.:
|_________________|
Please bring this paper with you. We
will draw a blood sample so please do not eat for at least 8 hours
before your appointment. You
may drink water during this time. Don’t
forget to collect your urine sample in the morning.
Bring
your urine sample with you.
Don’t forget to bring all your
medication for us to see.
[If you are a past participant in the
[insert site]
PFAS Blood Testing Program,
please bring a copy of your results
report.] If
you are unable to keep this appointment,
please
call to set up another time.
Toll-free
(xxx)xxx-xxxx
If you take diabetic medication, see
special instructions.
Multi-site Study
Appointment Reminder Card
Appointment Information
for Your
Multi-site Study Interview We
will arrive at your home on the date and time below:
Day: |_________________|
Date: |__|__|/|__|__|/|__|__|
Time: |__|__|:|__|__|
□ AM
□
PM
Study ID No.:
|_________________| We
will draw a blood sample so please do not eat for at least 8 hours
before your appointment. You
may drink water during this time. Don’t
forget to collect your urine sample in the morning.
Don’t forget to gather all your
medication for us to see.
[If you are a past participant in the
[insert site]
PFAS Blood Testing Program,
please provide a copy of your results
report.] If
you are unable to keep this appointment,
please
call to set up another time.
Toll-free
(xxx)xxx-xxxx
If you take diabetic medication, see
special instructions.
Multi-site Study
Appointment Reminder Card – Instructions
Instructions for Study Participants
On the day of your appointment
Fasting: Do not eat or drink for at least 8 hours before your appointment. Do not have candy, gum, or soda. Drinking water is fine. Take all your medications with water only.
If you have diabetes and take insulin or other medications, we will schedule your appointment as early in the morning as possible. Please fast for at least 8 hours if your meal and medication plan allows. If you must eat before your appointment, please eat fat-free or low-fat items and take your medications as usual. Write down what you ate and when you ate it.
First Morning Voided Urine Collection: Using the supplies we sent in your Appointment Packet, collect a first morning voided specimen. Note the time of collection of the specimen on the label of the container. To reduce contamination, the specimen should be a clean catch “mid-stream” sample.
Medications: Please have all of your regular medications that you have taken for the past two weeks with you. Putting them in a plastic bag will make it easy. We want to know about:
Prescriptions
Over-the-counter medicines
Supplements and vitamins
Fish oil
Herbal remedies
If any of your medications need to be kept chilled, please leave them in your refrigerator. Make a note to tell us about them.
[Insert site] PFAS Blood Testing Program Results: We would like to record your prior results to compare with your current ones. Please provide a copy of the results report for us to see.[if applicable]
Questions: If you have any questions, please contact us at our study phone number [INSERT TOLL FREE TELEPHONE NUMBER]. Thank you for taking part in this study.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CDC User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |