Form:Canary: PASS Follow-up Supplemental Consent v2.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 1319)
* 1319Date participant signed consent form (MM/DD/YYYY): (Go To: 423)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 5515)
* 5515Has the participant authorized the release of personal information? (Go To: 1097)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Not collected (2)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)