Att3_5_ApptReminderCard_20131205

Attachment 3.5

Anniston Community Health Survey: Follow-up Study and Dioxin Analyses

Appointment Reminder Card – CCHD (page 1 of 2)

Appointment Information for Study Interview

Calhoun County Health Department

3400 McClellan Blvd, Anniston, AL 36201

256-237-7523

Day: _______________________

Date: ___ ___ / ___ ___ / ___ ___

Time: ___ ___ : ___ ___  a.m.  p.m.

Participant #: __ - __ __ __ __ - __ __ __ __

Please bring this paper with you.

We will draw a blood sample so please do not eat for

8 hours before your appointment.

You may drink water during this time.

If you take diabetic medication, see special instructions.

Don’t forget to have all your medication for us to see.

If you are unable to keep this appointment,

please call to set up another time.

Toll-free (855) 822-1778

Appointment Reminder Card – West Anniston (page 1 of 2)

Appointment Information for Study Interview

West Anniston Foundation

1700 W 10th St, Anniston, AL 36201

Toll-free (855) 822-1778

Day: _______________________

Date: ___ ___ / ___ ___ / ___ ___

Time: ___ ___ : ___ ___  a.m.  p.m.

Participant #: __ - __ __ __ __ - __ __ __ __

Please bring this paper with you.

We will draw a blood sample, so please do not eat for

8 hours before your appointment.

You may drink water during this time.

If you take diabetic medication, see special instructions.

Don’t forget to have all your medication for us to see.

If you are unable to keep this appointment,

please call to set up another time.

Toll-free (855) 822-1778

Appointment Reminder Card – Home Visit (page 1 of 2)

Appointment Information for Study Interview

We will arrive at your home on the date and time below:

Day: _______________________

Date: ___ ___ / ___ ___ / ___ ___

Time: ___ ___ : ___ ___  a.m.  p.m.

Participant #: __ - __ __ __ __ - __ __ __ __

We will draw a blood sample, so please do not eat for

8 hours before your appointment.

You may drink water during this time.

If you take diabetic medication, see special instructions.

Don’t forget to have all your medication for us to see.

If you are unable to keep this appointment,

please call to set up another time.

Toll-free (855) 822-1778

Appointment Reminder Card – Instructions (page 2 of 2)

Instructions

On the day of your appointment

Fasting: Do not eat or drink for at least 8 hours before your appointment. Do not have candy, gum, or soda. Drinking water is fine. Take all your medications with water only.

If you have diabetes and take insulin or other medications, we will schedule your appointment as early in the morning as possible. Please fast for at least 8 hours if your meal and medication plan allows. If you must eat before your appointment, please eat fat-free or low-fat items and take your medications as usual. Write down what you ate and when you ate it.

Medications: Please have all of your regular medications that you have taken for the past two weeks with you. Putting them in a plastic bag will make it easy. We want to know about:

• Prescriptions

• Over-the-counter medicines

• Supplements and vitamins

• Fish oil

• Herbal remedies

• If any of your medications need to be kept chilled, please leave them in your refrigerator. Make a note to tell us about them.

Questions: If you have any questions, please contact us at our toll-free phone number (855) 822-1778. Thank you for taking part in this study.