Form	Form Name	Rev.	Date
AP	Automated Perimetry	2	01 Sep 08
AR	Antiretroviral Treatment History	1	02 Jun 05
BH	Baseline Medical History	5	04 Oct 07
BT	Baseline Treatment History	5	20 Jan 06
CC	Cardiovascular/Cerebrovascular Events	1	29 Sep 05
CF	Telephone Contact Form	1	07 Oct 08
CH	Choroidopathy	1	28 Oct 98
CL	Patient Closeout Notification Form	1	01 Nov 12
CN	Cranial Nerve/Motility Abnormality	1	28 Oct 98
CR	Cardiovascular/Cerebrovascular Risk Profile	1	31 Oct 05
CV	CMV Retinitis	1	03 Nov 08
DC	Data Entry Certification/Decertification	1	25 Mar 03
DD	Death Documentation	1	04 Aug 98
DR	Death Report	1	12 May 10
DS	Clinician versus FPRC Disagreement	1	28 Sep 06
EE	Eye Exam	3	01 Sep 08
EF	Enrollment Form	5	01 Sep 08
EH	Eye History	2	01 Sep 08
FH	Followup Medical History	5	08 Feb 13
FT	Followup Treatment History	5	27 Sep 07
HL	HIV Viral Load	3	31 May 11
HR	Herpetic Retinitis	1	28 Oct 98
HS	Hematology and Serum Chemistry Report	3	15 Mar 07
KC	Keratitis/Conjunctivitis	1	04 Aug 98
LA	Lymphocyte Subset Analysis Report	1	04 Aug 98
LR	Laboratory Range Report	1	04 Aug 98
MF	Medical File Contents	1	04 Aug 98
MO	Notification of Major Ocular Complication	3	01 Sep 08
MP	Missed Photographs Fax	2	04 Feb 10
MV	Missed Visit	3	01 Sep 08
ON	Optic Nerve Abnormality	2	22 Jul 99
PC	Personnel Certification	2	15 Jan 03
PD	Personnel Decertification	1	20 Nov 06
PL	Patient Location Information	2	16 Dec 02
PT	LSOCA Photograph Transmittal Log	5	15 Jan 08
QL	Quality of Life	2	06 May 08
	Quality of Life (large print)	2	06 May 08
RD	Retinal Detachment/Repair	1	06 Apr 99
SC	Specimen Collection/Processing	1	08 Apr 10
SD	Syphilitic Eye Disease	1	04 Aug 98
SF	Specimen Shipment Fax Coversheet	2	01 Sep 08
SP	Specimen Processing Checklist	1	25 Aug 05
SS	Specimen Shipment Log	1	20 Jul 09
ST	Specimen Tracking	1	31 Aug 98
TM	Transmittal Form	1	04 Aug 98
TN	Permanent Transfer Notification	2	01 Sep 08
TR	Toxoplasmic Retinitis	1	22 Jan 99
UE	Unusual Events	2	01 Sep 08
UN	Non-infectious Uveitis	2	15 Nov 00
VA	Visual Acuity/Contrast Sensitivity	1	10 Aug 00
VC	Cell Viability/Recovery Specimen Shipment Log	1	09 Jul 07
VF	Goldmann Visual Field Record	1	01 Sep 08
VG	Visit Guide	4	30 Apr 10
VL	Visual Acuity Lighting Log	1	04 Aug 98
VQ	Visual Functioning Questionnaire - 25	1	10 Sep 08
	Visual Functioning Questionnaire - 25 (Large Print)	1	10 Sep 08

 

Supplemental Forms

Form	Form Name	Rev.	Date
AF	Archive Inventory Form	1	14 Aug 13
PP	Publication (PP form can be completed electronically. However, the printed copy should be signed before mailing).	1	16 Feb 01
SPF	Study Proposal Forms (SPF form can be completed electronically. However, the printed copy should be signed before mailing).	1	13 Mar 09
SL	Specimen Label Request	1	19 Apr 12