Environmental Tap Water Pharmaceutical (TWF) Sample Distribution Script

NCS Phase 2b

Environmental Tap Water Pharmaceutical (TWF) Sample Distribution Script

(EH, PB, HI) V1.0

Event:	Pregnancy Visit 1
Participant:	Pregnant Woman
Domain:	Environmental
Type of Document:	Script
Recruitment Groups:	EH, PB, HI

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Environmental Tap Water TWF Sample Distribution Script

Here is a Tap Water (TWF) sample collection kit so that you may collect the TWF sample yourself. Your collection of this TWF sample will help us learn more about the tap water in homes. Also, it will help us learn if participants have problems with the procedures for collecting tap water samples, so that one day we may mail the kits to participants directly.

To collect the TWF sample, you will fill three bottles with water from your kitchen faucet or other tap and complete the Tap Water TWF Questionnaire.

You will then package the bottles on ice packs and ship them to the designated laboratory by FedEx using the pre-paid, self-addressed Fedex label and shipping container provided.

The Tap Water TWF Questionnaire will be mailed to our office by regular mail in the enclosed pre-paid, self-addressed envelope.

Please place the ice packs provided in the kit in your freezer as soon as possible. Ice packs should be frozen when you ship the TWF sample.

If possible, on the day of sample collection, before collecting the sample, avoid handling or using the following: caffeine, tobacco, home cleaning agents, or personal care products, such as antibacterial soaps, hand sanitizers, or lotions.

It is important that you complete the collection of each sample before starting the collection of other samples. Please keep the TWF sample separate from TWQ sample to avoid mixing of two different samples. TWF and TWQ samples should be packaged and shipped to the designated laboratories in separate shippers.

Do you have any questions about the Tap Water TWF sample collection kit?

IF ASKED WHAT TWF MEANS: TWF is a code for the laboratory so they know the difference in the two sample types collected. There are two sample codes – a TWF and a TWQ sample.

THIS SCRIPT MAY BE MODIFIED AS APPROPRIATE IF OTHER ENVIRONMENTAL SAMPLE COLLECTION KITS ARE BEING DISTRIBUTED AT THIS VISIT.

ENV Tap Water Pharmaceutical (TWF) Sample Distribution Script (EHPBHI), June 2011, V1.0 0