The Systolic Hypertension in the Elderly Program (SHEP)
Forms
Record
Format
1) Randomizatin Record
PDF
2) Demographics and Medical History
PDF
3) Baseline Medical History
PDF
4) Baseline Visit 1
PDF
5) Baseline Visit 2
PDF
6) Clinic Visit Documentation
PDF
7) Annual Clinic Visit
PDF
8) ECG Coding
PDF
9) Local Laboratory Results
PDF
10) Central Laboratory Results
PDF
11) Receipt of Alert Level from Central Laboratory
PDF
12) Scan Coding form for Stroke
PDF
13) Urine Chlorthalidone Results
PDF
14) CT Scan Coding form for Dementia
PDF
15) Silent MI
PDF
16) Initial Notification of Morbid Event
PDF
17) Final Report of Morbid Event
PDF
18) Initial Notification of Death
PDF
19) Final Report of Death
PDF
20) Neurological Evaluation for Stroke
PDF
21) Neurological Evaluation for TIA
PDF
22) Short-care form
PDF
23) Diagnostical Evaluation for Dementia
PDF
24) Diagnostic Criteria for Depression
PDF
25) Activities of Daily Life
PDF
26) Social Network Questionnaire
PDF
26) Behavioral Evaluation
PDF
27) Compliance Evaluation
PDF
28) General Well-Being
PDF
29) Side Effects Questionnaire
PDF
30) Protocol Reveiw and Medical Scheduling Decision
PDF
31) Annual Medical, Medication, and Habits History
PDF
32) Report of Deviation from Protocol
PDF
33) Report of Study Drug Disclosure
PDF
34) Documentation of Refusal or Lost to Follow-up
PDF
35) Report of Missed Quarterly or Annual Visit
PDF
36) SHEP Satisfaction/ Attitude Questionnaire
PDF
37) Close-out/ Transition
PDF
38) Transition Telephone Contact Record
PDF
39) Monitoring of SHEP Non-Fatal Events
PDF
40) Monitoring of SHEP Deaths
PDF
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