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 Chapter & Description
0 Table of Contents
1 Prescreen Eligibility Form
2 SV1 Blood Pressure Form
3 SV1 Visit Form
4 Eligibility Questionnaire
5 Rose Questionnaire PVD
6 Baseline Rose Questionnaire - Angina
7 Follow-Up Rose Questionnaire - Angina
8 Diet and Physical Activity Change Checklist
9 SV2 Blood Pressure Form
10 SV2 Visit Form
11 Baseline Medication Use Questionnaire
12 Local Lab Worksheet
14 SV3 Blood Pressure Form
15 SV3 Visit Form
16 Baseline Symptoms Questionnaire
17 Eligibility Review Questionnaire
18 7-Day Physical Activity Recall
19 24 Hour Food Interviews
20 Central Lab Collection Form - Baseline 24-Hour Urine
21 Central Lab Collection Form - Baseline Fasting Blood
22 Alcohol Intake Questionnaire
23 Quality of Life Questionnaire
24 Patient History Questionnaire
25 Perceived Stress Questionnaire
26 Fitness Test Form
27 4th Baseline Blood Pressure Form
28 Participant Closeout Form
30 Adverse Events Form
31 Safety Review Form
32 Blood Pressure Escape Form - Screening
33 3 Month Visit Blood Pressure Form
36 Vigorous Exercise Worksheet
37 Premature Termination Form
40 Diet and Physical Activity Change Questionnaire
41 Screening motivational Session Notes
42 PREMIER A: Intervention Data Collection Form
43 PREMIER B: Intervention Data Collection Form
44 PREMIER C: Intervention Data Collection Form
45 Exercise Confidence Questionnaire
46 Eating Habits Confidence Questionnaire
47 Social Support and Eating Habits Questionnaire
48 Social Support and Exercise Questionnaire
49 Perceived Body Image Questionnaire
50 Recruitment Activity Form
51 Blood Pressure Escape Form - 3, 12 Month Visits
52 Blood Pressure Escape Form - 6, 18 Month Visit Clusters
54 12 Month Visit Blood Pressure Form
56 3-Month Visit Form
57 6-Month Visit Form
58 12-Month Visit Form
59 18-Month Visit Form
60 Randomization Checklist
62 Central Lab Collection Form - 6-Month 24-Hour Urine
63 Central Lab Collection Form - 6-Month Fasting Blood
64 Central Lab Collection Form - 18-Month 24-Hour Urine
65 Central Lab Collection Form - 18-Month Fasting Blood
67 6 Month Visit Blood Pressure Form: Cluster Visit 1
68 6 Month Visit Blood Pressure Form: Cluster Visit 2
69 6 Month Visit Blood Pressure Form: Cluster Visit 3
70 6 Month Visit Blood Pressure Form: Cluster Visit 4
71 18 Month Visit Blood Pressure Form: Cluster Visit 1
72 18 Month Visit Blood Pressure Form: Cluster Visit 2
73 18 Month Visit Blood Pressure Form: Cluster Visit 3
75 General Blood Pressure Form
76 Intervention Suspension Form - Folate/Carotenoid/Vit.B12
77 CDC Lab Collection Form
78 Follow-Up Symptoms Questionnaire
79 Follow-Up Medication Use Questionnaire
82 Beliefs and Attitudes of PREMIER Participants
83 Blood Pressure Escape Form - 3 Month Visit
84 Blood Pressure Escape Form - 12 Month Visit
90 Participant Transfer Form
100 Participant Contact Information
102 Medications Allowed During PREMIER
104 Food Interview Instruction Sheet
105 Food Interview Convenient Times Schedule
106 SV1/SV2 Activity Fact Sheet
107 SV3 Activity Fact Sheet
200 One-Day Food Record Screening Form
201 Weight Loss Medications That Affect Blood Pressure
202 Intervention Alert Worksheet
© Kaiser Permanente Center for Health Research