Attachment 12d
Blood Pressure Methodology Phase 2 Form
Form Approved OMB No. 0920-0950 Exp. Date xx/xx/20xx
Assurance of Confidentiality – All information which would permit identification of an individual, a practice, or an establishment will be held confidential, will be used only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347). By law, every employee as well as every agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you.
NOTICE-Public reporting burden of this collection of information is estimated to average 30 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333. ATTN: PRA (0920-0950).
This attachment captures the time needed for participants to have the MEC physician obtain Blood Pressure (BP) values as usually done in NHANES using mercury and to have the health technicians obtain BP values using the Omron device. The second phase of the study will focus on comparing mean BP values assessed separately by mercury and Omron devices.
Suggested Script
For Phase Two: “As part of your examination today, you are having your blood pressure taken with two different devices. This is because we are doing a study to compare two different blood pressure measuring devices. Your participation to have a second blood pressure taken for the study is voluntary. The physician will (or may have already) given you information about your blood pressure.
Blood Pressure (ages 8 years and older)*
Have you had any of the following in the past 30 minutes? (food, coffee, alcohol, cigarettes) Check all that apply:
Arm selected Right/left/Could not obtain
Cuff size selected Infant/Child/Adult/Large Arm/Thigh
Heart Rate/Pulse Beats per minute
Pulse type
Radial/Brachial
Maximum Inflation Level mm Hg
Systolic Blood Pressure (Readings 1,2,3) mm Hg
Diastolic Blood Pressure (Readings 1,2,3) mm Hg
Average Blood Pressure mm Hg (mean of last 2 measurements will be used)
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Dupree, Natalie (CDC/OPHSS/NCHS) |
File Modified | 0000-00-00 |
File Created | 2021-01-20 |