Form:	NOD Follow-up Abstraction and/or In-Person v5.0

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 1832)
1832	Participant initials: (Go To: 2176)
* 2176	Visit code (Go To: 423)
	Permissible Values (value): 6 months (6)
	12 months (12)
	24 months (24)
	36 months (36)
* 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: 3685)
* 3685	Source of information collection (Go To: 4223)
	Permissible Values (value): Patient self-report (1)
	Electronic medical record (4)
	Measured at in-person visit (9)
	Other (95)
* 4223	Weight (value): (Go To: 4224)
* 4224	Weight (unit): (Go To: 4243)
	Permissible Values (value): kg (kilograms) (1)
	lbs (pounds) (2)
* 4243	Date weight recorded (MM/DD/YYYY): (Go To: 3892)
* 3892	Source of information, 2nd source (Go To: 2980)
	Permissible Values (value): Patient self-report (1)
	Electronic medical record (4)
	Measured at in-person visit (9)
	Other (95)
* 2980	Currently taking any medications or supplements (including herbal or nutrient supplements)? (Go To: 1334)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3144)
	Unknown (99)
* 3144	Number of loops: (Go To: 3200)
	Permissible Values (value): 1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	7 (7)
	8 (8)
	9 (9)
	10 (10)
* 3200	Line number or identifier (system-generated): (Go To: 1873)
* 1873	Medication Name: (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: 1334)
* 1334	New primary cancer [other than basal/squamous cell skin cancer] confirmed by a doctor since last routine study contact? (Have you been diagnosed with a new primary cancer [other than basal/squamous cell skin cancer] since your last routine study contact?) (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1343)
	Unknown (99)
* 1343	Cancer type/location (Go To: 1097)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Cervix (5)
	Colon (6)
	Endometrium (22)
	Esophagus (7)
	Gall bladder (40)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Leukemia (11)
	Liver (10)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Mesothelioma (42)
	Multiple myeloma (44)
	Ovary (14)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Testis (24)
	Thyroid (20)
	Uterus (21)
	Vagina (26)
	Other (95)
	Unknown (99)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)