| Form: | (EXPIRED) Canary: PASS Follow-up Supplemental Consent v2.0 |
|---|
| CDE ID | CDE Description | ||
|---|---|---|---|
| * 421 | EDRN Participant ID (Go To: 1319) | ||
| * 1319 | Date participant signed consent form (MM/DD/YYYY): (Go To: 423) | ||
| * 423 | EDRN Protocol ID (Go To: 422) | ||
| * 422 | EDRN Site ID (Go To: 929) | ||
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 5515) | ||
| * 5515 | Has the participant authorized the release of personal information? (Go To: 1097) | ||
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| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |