Biologic Specimen and Data Repository Information Coordinating Center

Initial Medical History and Physical Exam - 03 INT (PDF - 378.1 KB)
Laboratory Results Form - 10 LAB (PDF - 157.0 KB)
Laboratory Results Form - 11 NLB (PDF - 164.4 KB)
Liver Biopsy Histologic Data - 17 LHS (PDF - 81.0 KB)
Liver Biopsy Report - 16 LBI (PDF - 72.1 KB)
Liver-Spleen Scan and Barium Swallow Report - 19 LSP (PDF - 64.5 KB)
Medical History and Follow-Up - 04 MHF (PDF - 481.7 KB)
Medical History and Follow-Up - 05 NMF (PDF - 475.6 KB)
Medical Records Summary - 21 ABS (PDF - 205.6 KB)
Non-Compliance - 22 NON (PDF - 77.9 KB)
Patient Telephone Questionnaire - 14 NQX (PDF - 849.3 KB)
Post-Transfusion Hepatitis Questionnaire - 01 QUX (PDF - 1.2 MB)
Proxy Telephone Questionnaire - 15 NPX (PDF - 975.9 KB)