Form:	NOD Eligibility Checklist v5.0

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 1832)
1832	Participant initials: (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: 2647)
* 2647	Staff ID (secondary): (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 1319)
* 1319	Date participant signed consent form (MM/DD/YYYY): (Go To: 4860)
* 4860	Date participant signed an authorization for the release of their protected health information. (HIPAA)(MM/DD/YYYY) (Go To: 4922)
* 4922	Has the participant authorized genetic testing? (Go To: 2631)
	Permissible Values (value): No (0)
	Yes (1)
	Not collected (2)
	Refused (88)
	Unknown (99)
* 2631	Has the participant authorized future contact for research purposes? (Go To: 3780)
	Permissible Values (value): No (0)
	Yes (1)
	Not collected (2)
	Refused (88)
	Unknown (99)
* 3780	Age at cohort entry: (Go To: 3214)
* 3214	Number of subform loops to record 2: (Go To: 3201)
	Permissible Values (value): 1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	7 (7)
	8 (8)
	9 (9)
	10 (10)
	11 (11)
	12 (12)
	13 (13)
	14 (14)
	15 (15)
	16 (16)
	17 (17)
	18 (18)
	19 (19)
	20 (20)
	21 (21)
	22 (22)
	23 (23)
	24 (24)
	25 (25)
	26 (26)
	27 (27)
	28 (28)
	29 (29)
	30 (30)
	31 (31)
	32 (32)
	33 (33)
	34 (34)
	35 (35)
	36 (36)
	37 (37)
	38 (38)
	39 (39)
	40 (40)
	41 (41)
	42 (42)
	43 (43)
	44 (44)
	45 (45)
	46 (46)
	47 (47)
	48 (48)
	49 (49)
	50 (50)
	51 (51)
* 3201	Line number or identifier 2 (system-generated): (Go To: 4928)
* 4928	Glycemic parameter or Parameter of Diabetes Mellitus (PDM), test type (Go To: 4929)
	Permissible Values (value): Fasting blood glucose (FBG), mg/dL (1)
	Hemoglobin A1c (HbA1c), % (2)
	Random Blood Glucose (RBG), mg/dL (3)
	2h Post Glucose (PG), mg/dL (11.1 mmol/L) during OGTT (5)
* 4929	Glycemic parameter or Parameter of Diabetes Mellitus (PDM), test result (Go To: 4930)
* 4930	Parameter of Diabetes Mellitus (PDM), test date (Go To: 4931)
* 4931	Parameter of Diabetes Mellitus (PDM), test setting (Go To: 3158)
	Permissible Values (value): Inpatient (1)
	Outpatient (2)
	Emergency Department (3)
	Urgent Care (4)
	Unknown (99)
3158	Loop-specific comments: (Go To: 2153)
* 2153	Has participant authorized the use of their blood for this study? (Go To: 4850)
	Permissible Values (value): No (0) (Go To: End of Form)
	Yes (1)
* 4850	Is the participant, or authorized representative, willing to complete detailed questionnaire? (Go To: 4857)
	Permissible Values (value): No (0) (Go To: End of Form)
	Yes (1)
* 4857	Does the participant meet exclusion criteria for cancer treatment and/or recurrence? (Go To: 3028)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 3028	Diagnosed with study-related cancer?: (Go To: 3156)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 3156	Ever diagnosed with diabetes by a doctor? (Go To: 5017)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 5017	Ever diagnosed with hyperglycemia by a doctor? (Go To: 4873)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 4873	Has the participant used anti-DM medication in the time period that excludes them from the study? (2nd time asking on the same form) (Go To: 4858)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 4858	Is the participant is currently taking oral steroids? (Go To: 4859)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 4859	Has the participant had any steroid injections? (Go To: 4851)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 4851	In physician’s judgment, is the participant free from any co-morbidities that limit the participant's participation in the study? (Go To: 2980)
	Permissible Values (value): No (0)
	Yes (1) (Go To: End of Form)
* 2980	Currently taking any medications or supplements (including herbal or nutrient supplements)? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3144)
	Refused (88)
	Unknown (99)
* 3144	Number of loops: (Go To: 3200)
	Permissible Values (value): 0 (0)
	1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	7 (7)
	8 (8)
	9 (9)
	10 (10)
	11 (11)
	12 (12)
	13 (13)
	14 (14)
	15 (15)
	16 (16)
	17 (17)
	18 (18)
	19 (19)
	20 (20)
	21 (21)
	22 (22)
	23 (23)
	24 (24)
	25 (25)
	26 (26)
	27 (27)
	28 (28)
	29 (29)
	30 (30)
* 3200	Line number or identifier (system-generated): (Go To: 1873)
* 1873	Medication Name: (Go To: 4962)
* 4962	Medication start date (MM/DD/YYYY): (Go To: 4862)
* 4862	Medication dose (Go To: 4938)
* 4938	Medication units (Go To: 4937)
* 4937	Medication category (Go To: 5278)
	Permissible Values (value): Anti-DM (1)
	Steroid (2)
	Insulin (5)
	Other (95)
5278	Drug descriptor ID (auto-entered) (Go To: 5437)
* 5437	Medication frequency (Go To: 3163)
	Permissible Values (value): 1 per day (1)
	2 per day (2)
	3 per day (3)
	4 per day (4)
	PRN (20)
	Other, specify: (97) (Go To: 5438)
	Unknown (99)
* 5438	Medication frequency, other, specify (Go To: 3163)
3163	Loop-specific comments 2: (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)