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    BasicDemographyForm DocumentoD

    Uploaded by

    Luis Agudelo
    This document collects basic demographic information for a study participant, including name, contact details, date of birth, age, ethnicity, race, gender, height, weight, and BMI. Space is also provided for general comments. The form requests identifying and medical information to characterize the participant and document their details for a research study.

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    BasicDemographyForm DocumentoD

    Uploaded by

    Luis Agudelo
    14 views2 pages
    This document collects basic demographic information for a study participant, including name, contact details, date of birth, age, ethnicity, race, gender, height, weight, and BMI. Space is also provided for general comments. The form requests identifying and medical information to characterize the participant and document their details for a research study.

    Original Description:

    Original Title

    BasicDemographyForm_DocumentoD (1)

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    This document collects basic demographic information for a study participant, including name, contact details, date of birth, age, ethnicity, race, gender, height, weight, and BMI. Space is also provided for general comments. The form requests identifying and medical information to characterize the participant and document their details for a research study.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    14 views2 pages

    BasicDemographyForm DocumentoD

    Uploaded by

    Luis Agudelo
    This document collects basic demographic information for a study participant, including name, contact details, date of birth, age, ethnicity, race, gender, height, weight, and BMI. Space is also provided for general comments. The form requests identifying and medical information to characterize the participant and document their details for a research study.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 2

    Documento de Carton

    Page 1
    Basic Demography Form

    Study ID
    __________________________________

    Contact Information
    Primer Nombre
    __________________________________

    Last Name
    __________________________________

    Street, City, State, ZIP

    __________________________________________

    Phone number
    __________________________________
    (Include Area Code)

    E-mail
    __________________________________

    Date of birth
    __________________________________

    Age (years)
    __________________________________

    Ethnicity

    Hispanic or Latino NOT Hispanic or Latino Unknown / Not Reported

    Race American Indian/Alaska Native


    Asian
    Native Hawaiian or Other Pacific Islander
    Black or African American
    White
    More Than One Race
    Unknown / Not Reported

    Gender Female
    Male
    Other
    Prefer not to say

    Height (cm)
    __________________________________

    Weight (kilograms)
    __________________________________

    BMI
    __________________________________

    02-27-2023 11:11 projectredcap.org


    Page 2

    General Comments
    Comments

    __________________________________________

    02-27-2023 11:11 projectredcap.org

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