ParticipantResultsLetters

OMB#: 0925-0216

Exp. 12/2007        

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0216). Do not return the completed form to this address.

 

OMB#: 0925-0216

Exp. 12/2007

Letter Date _______________ Exam Date _________________

______________________________________,

A report of your recent examination at the Framingham Heart Study has been forwarded to:

_____________________________________________________________________

The examination at the Heart Study focuses on cardiovascular disease and is NOT a full exam. You need to see your own doctor for periodic complete check-ups.

Any clinical abnormalities requiring that you see your physician are written in the following space. Some test results are not immediately available; any abnormalities detected will be sent directly to your doctor.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

We look forward to seeing you again and appreciate your support. Your cooperation makes possible further progress in the determination of causes and ways of preventing heart disease.

Thank you for your continuing support.

Sincerely,

Examiner_______________________ Daniel Levy, M.D.

Medical Director

Framingham Heart Study

EXAMINATION REPORT

Doctor’s Name:	Name:
Address:	Exam Date:
	ID:

_______________________________________________________________________

The Heart Study evaluation focuses on cardiovascular disease and is NOT a comprehensive exam. Our research exam does NOT take the place of regular check-ups with a complete physical examination. The following tests are done on a routine basis: Lipids, Glucose, Pulmonary Function, Ankle-Brachial BP. Abnormal findings for non-invasive C-V tests will be forwarded separately.

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BLOOD PRESSURE:	FIRST READING	SECOND READING
Systolic Blood Pressure
Diastolic Blood Pressure

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ECG DIAGNOSIS:

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SUMMARY OF SIGNIFICANT HISTORY AND PHYSICAL EXAM: