WHI Study Documentation

Clinical Trial Data Collection Forms

• Form 2 - Eligibility Screen
• Form 4 - HRT Washout
• Form 10 - HRT Management and Safety Interview
• Form 17 - CaD Management and Safety Interview
• Form 20 - Personal Information
• Form 30 - Medical History
• Form 31 - Reproductive History
• Form 32 - Family History
• Form 33 - Medical History Update
• Form 33D - Medical History Update Detail
• Form 34 - Personal Habits
• Form 35 - Personal Habits Update
• Form 37 - Thoughts and Feelings
• Form 38 - Daily Life
• Form 39 - Cognitive Assessment
• Form 43 - Hormone Use
• Form 44 - Current Medications
• Form 45 - Current Supplements
• Form 54 - Change of Medications
• Form 60 - Food Questionnaire (FFQ)
• Form 80 - Physical Measurements
• Form 81 - Pelvic Exam
• Form 82 - Endometrial Aspiration
• Form 83 - Transvaginal Uterine Ultrasound
• Form 84 - Clinical Breast Exam
• Form 85 - Mammogram
• Form 90 - Functional Status
• Form 92 - Pap Smear
• Form 100 - Blood Collection and Processing
• Form 120 - Initial Notification of Death
• Form 121 - Report of Cardiovascular Outcome
• Form 122 - Report of Cancer Outcome
• Form 123 - Report of Fracture Outcome
• Form 124 - Report of Death
• Form 126 - Report of Venous Thromboembolic Disease (HRT)
• Form 130 - Cancer Surveillance Form (Central)
• Form 131 - Report of Hysterectomy (HRT))
• Form 132 - Report of Stroke Outcome (Central)