L-PVDOMICS STUDY L-PVDOMICS STUDY FORMS/DATA TRANSMISSION FORMATS TABLE OF CONTENTS – as of 08/26/2021
CENTER PARTICIPANT FORMS
L-PVD Form #	Version Date*	Participation Level	Form Name
---	04/10/2016	L1, L2, L3	Participant Contact Information and Pre-Screening Sheet (not entered into study database)
499	08/06/2020	L1	Screening for COVID-19 Prior to Enrollment
500	08/06/2020	L1, L2, L3	L-PVDOMICS Enrollment Form
501	08/06/2020	L1	L2 Enrollment Transition to L1 Enrollment
502 502C	08/25/2021 08/26/2021	L1, L2, L3	PVD Assessment Form Comparator Additional PH Comorbidities
503	10/04/2019	L1, L2, L3	Non-PVD Comorbidity, Medical and Surgical History Form
505	01/14/2020	L1, L2	Exposure History Form
510	10/04/2019	L1, L2, L3	PH and Concomitant Medications Form
515	10/04/2019	L1, L2	Functional Class
520	10/04/2019	L1	Study Visit Vital Signs Form
521	11/07/2019	L1, L2	Female Reproductive History Form
531	10/04/2019	L1	Waist/Hip Measure Form
532	10/04/2019	L1, L2, L3	Height, Weight Form
533	11/18/2020	L1	6 Minute Walk Test (6MWT) Form
550	04/08/2020	L1	Sleep Study Initialization, Demo, Placement
551	04/17/2020	L1	Participant Sleep/Nocturnal Oximetry Questionnaire Administrative Form
552	04/30/2020	L1	Sleep Study Download Transmit Form
555	03/01/2020	L1,L2,L3	Alternative Sleep Study Form
570	10/04/2019	L1, L2	Survey Instrument (SF-36v2) Form – English (administrative form is attached to document)
570S	10/04/2019	L1, L2	SF-36v2 Questionnaire – Spanish Administration Form
571	10/04/2019	L1, L2	Minnesota Living With Heart Failure® Questionnaire (MLHF) – English Admin. Form for MLHF
571S	10/04/2019	L1, L2	Admin Form for MLHF Questionnaire – Spanish Admin. Form for MLHF
572	10/04/2019	L1, L2	emPHasis-10 Quality of Life Form – English Admin. Form for emPHasis emPHasis-10 darker print version
572S	10/04/2019	L1, L2, L3	emPHasis-10 Questionnaire – Spanish Admin. Form for emPHasis
590	09/11/2020	L1	COVID-19 2-Week Follow-up
600	06/26/2020	L1, L2, L3	Center CBC w Diff Results
601	06/26/2020	L1, L2, L3	Center Complete Metabolic Panel (CMP) Results
644	12/02/2019	L1, L2, L3	Locally Read ECG Results
650	10/04/2019	L1	Echocardiogram (ECHO) Transmittal Form
653	10/04/2019	L1, L2, L3	Center Transmittal of Chest CT Images and Report Form
671	10/04/2019	L1, L2, L3	Pulmonary Function Testing
680	03/03/2020	L1, L2, L3	Clinical Center Right Heart Catheterization (RHC)
689	02/28/2020	L1, L2, L3	Center Cycle Ergometer CPET (Combined 290/291 and addendum)
800	03/30/2020	L1	Center OMICS Blood Collection – Drawing Samples Form
801	10/04/2019	L1	Center OMICS Blood Collection – Processing Samples Form
803	10/04/2019	L1	Ctr Blood Collection – Shipping of Frozen Cryovials and PAXgene® Tubes to Biorepository Form
805	10/04/2019	L1	Ctr Blood Collection – Processing PAXgene® “Rest” Sample Form
820	10/04/2019	L1	Center Urine Collection Sample
821	10/04/2019	L1	Center Urine Collection Processing Sample
830	10/04/2019	L1	Center BTS System Specimen Storage Log
836	10/04/2019	L1	Center BTS System FROZEN Specimen Shipment Log
900		L1	6MWT Event Notification Form
901		L1	6MWT Detailed Adverse Events Form
			DCC CORE Forms
553	05/13/2020	n/a	Sleep Core Receipt and QA Review
556	03/01/2020	n/a	Sleep Core Review of Alternative Sleep Study Form
262	05/14/2020	n/a	Core CT Scan Center Results Form
620-Data dictionary	12/20/2019	n/a	Clinical Chemistry Core Results Data Transmission
660-Data Dictionary		n/a	ICL Core Echocardiogram (ECHO) Results Data Transmission
856	10/04/2019	n/a	Core BTS FROZEN Specimen Received Log