6. Recruitment Tracking Form

Attachment 6.

Multi-site Study

Recruitment Tracking Form

Adult Study ID No. |_________________| (record any alias study IDs to ensure linkages)

Parent Study ID No. |_________________|

Child Study ID No. |_________________|

Contact Information Label

NW = Non-working Number NH = No One Home EN = Not Eligible EY = Yes Eligible

AN = Appointment Not Scheduled AS = Appointment Scheduled (note date/time) AR = Appointment Rescheduled (note date/time) AX = Appointment No-Show

CC = Consent Complete IP = Partial Interview IC = Completed Interview O = Other (explain)

No.	DATE mm/dd/yy	TIME hh:mm		OUTCOME CODE(S)	COMMENTS	INTERVIEWER
1	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
2	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
3	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
4	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
5	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
6	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
7	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
8	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
9	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
10	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
11	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM
12	|__|__|/|__|__|/|__|__|	|__|__|:|__|__|	AM PM