TLC Trial Form SCREEN 03 Parent Guardian Interview Pre - NIEHS: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Center ID, Screening ID, and Visit Code at the top of the form. These identifiers are crucial for tracking and managing the interview process.
In Section 1, input your child's birth weight in either pounds and ounces or grams as specified. This information is essential for medical assessments.
Proceed to Section 2, where you will indicate if your child has any illnesses requiring frequent doctor visits or special medications. Select 'Yes' or 'No' and provide details if applicable.
Continue through Sections 3 to 7, answering questions about your child's current research study involvement, household dynamics, and your residency duration. Ensure accuracy for eligibility verification.
Complete the administrative matters section by filling in the date of the interview and signing as the interviewer. This finalizes your submission.

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TLC Trial Form SCREEN 03 Parent Guardian Interview Pre - NIEHS 2025

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TLC Trial Form SCREEN 03 Parent Guardian Interview Pre - NIEHS 2025

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