| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 2176) |
| * 2176 | Visit code (Go To: 1832) |
| | | Permissible Values (value): | 6 months (6) |
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| 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: 1389) |
| * 1389 | Reason for missed visit: (Go To: 5056) |
| | | Permissible Values (value): | Participant too ill (1) |
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| | | | Participant temporarily away from area (2) |
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| | | | Unable to contact participant (4) |
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| | | | The site failed to make attempt to contact participant during visit window (5) |
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| | | | Participant disenrolled from health system (6) |
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| | | | Other, specify: (97) (Go To: 2185) |
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| * 2185 | Reason for missed visit (Other, specify): (Go To: 5056) |
| * 5056 | Completion status of missed visit (Go To: 1097) |
| | | Permissible Values (value): | Partially missed visit (1) |
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| | | | Completely missed visit (2) |
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| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |