Report of Findings

Att 1d 011420.docx

National Health and Nutrition Examination Survey

Report of Findings

OMB: 0920-0950

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Attachment 1d


Form Approved

OMB No. 0920-0950

Exp. Date: 11/30/2021


Report of Findings - Example

Shape1

Jane Doe

101 Deer Lane

Buck, MI 00000


Dear Parent or Guardian,


We appreciate your child's participation in the National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. By taking part in this survey, your child has helped add to our knowledge about the health status of people living in the United States. The information we collect is used to evaluate the country's health problems, develop health programs, and improve the quality of medical care.


The examination given to your child was not a complete examination and was not intended to be a substitute for visits to his/her medical provider. However, the enclosed report contains results of your child's examination that may be useful to maintaining and promoting his/her health.


If you have any questions about the results of your child's examination, you can reach me on one of our toll-free numbers below between 7:30 AM and 4:30 PM Eastern Time, Monday through Friday.


English:

1-800-452-6115, press "1"

Chinese: 1-866-887-7996, press "1"

Spanish:

1-800-452-6115, press "2"

Korean: 1-866-887-7996, press "2"


Sincerely,




Vietnamese: 1-866-887-7996, press "3"



Shape2

Duong T. Nguyen, D.O.

Senior Medical Officer


Enclosure

123456 (Participant ID number)





These measurements were obtained as part of a survey and do not represent a medical diagnosis.

Interpretation of these measurements must be made by a physician.

Shape3

Date of Examination: XX/XX/XXXX

Participant Name: Jane Doe

Participant Age at Interview: 6 months

Participant Age at Exam: 6 months

Participant Gender: Female

SP ID: 123456


Body Measurements


Length: X ft. X in.

Weight: XX.X lbs.


These measurements were obtained as part of a survey and do not represent a medical diagnosis.

Interpretation of these measurements must be made by a physician.

Shape4


Complete Blood Count


White Blood Count

Result

11.8

Units

(x109 /L)

Flag

Reference Range

4.3 - 14.0*

Lymphocytes

57.8

(%)


21.6 - 68.8

Monocytes

7.2

(%)


4.2 - 14.4

Neutrophils

37.6

(%)


19.4 - 69.5

Eosinophils

0.6

(%)


0.6 - 9.9

Basophils

0.3

(%)


0.1 - 2.5

Red Blood Count

4.0

(x1012 /L)


4.0 - 5.3

NRBC

0.1

(/100 WBC)


0.0 - 0.3

Hemoglobin

13.7

(g/dL)


11.0 - 14.2

Hematocrit

36.8

(%)


32.5 - 41.9

MCV

75.4

(fL)


70.2 - 89.1

MCH

27.9

(pg)


23.3 - 30.8

MCHC

33.3

(g/dL)


32.4 - 35.5

RDW

12.8

(%)


11.3 - 15.4

Platelet Count

363

(x109 /L)


215 - 547


This finding was not confirmed by microscopy and follow-up may be necessary.


* Reviewers please note: CBC Reference ranges will vary based on age of infant and will be programmed for ranges of ages 0-12 months. Normal adult ranges listed here.


--- Test not done

^^^ Results Still Pending

<<< Lower than the limit of detection

>>> Above the limit of detection

vvv Delayed Results Number of hours fasted prior to blood draw: 0

Jane Doe, 6 months, Female, 123456, X/XX/2019;

Centers for Disease Control and Prevention,

N CHS 3311 Toledo Road, MS P08, Hyattsville, Maryland 20782


Laboratory - Blood Tests


Result

Units

Flag

Reference Range

Serum Folate

72.8

ng/mL


1 month16-72

> 1 month 4-20








Serum Ferritin

77

ng/mL


Newborn 25-200

1 month 200-600

2-5 months 50-200

6 mo. – 1 year 7-140






Transferrin Receptor

20

mg/dL


0 - ≤ 3 months 130-275

>3 months - <1 year 203-360


C Reactive protein

Vitamin D



0.1

25

mg/dL

ng/mL


0-0.5

> 20

Blood Lead

0.3

µg/dL


< 5

Total Blood Mercury

1.5

µg/L

L

< 5.8




--- Test not done

^^^ Results Still Pending

<<< Lower than the limit of detection

>>> Above the limit of detection

vvv Delayed Results Number of hours fasted prior to blood draw: 0

Jane Doe, 6 months, Female, 123456, X/XX/20xx;

Centers for Disease Control and Prevention,

N CHS 3311 Toledo Road, MS P08, Hyattsville, Maryland 20782





Laboratory Information


NHANES Mobile Examination Center Laboratory National Center for Health Statistics

3311 Toledo Road, MS P08 Hyattsville, Maryland 20782

Complete blood count

Centers for Disease Control and Prevention National Center for Environmental Health Nutritional Biomarkers Branch Laboratory 4770 Buford Highway, NE

MS F-55

Atlanta, GA 30341

Serum ferritin, transferrin saturation, vitamin D, serum folate and RBC folate

Centers for Disease Control and Prevention NCEH / DLS / IRAT

4770 Buford Hwy. Building 103, Labs 1117, 1119,

1103

Mailstop F-18

Atlanta, GA 30341-3724

Total urinary arsenic, blood lead, cadmium, manganese, total blood mercury, selenium, inorganic blood mercury, urinary nickel, urinary chromium, iodine (salt) and fluoride (water)

The following CLIA-certified laboratories performed the named tests on biologic specimens









Number of hours fasted prior to blood draw: 0

Jane Doe, 6 months, Female, 123456, X/XX/20xx;

Centers for Disease Control and Prevention,

NCHS 3311 Toledo Road, MS P08, Hyattsville, Maryland 20782




Shape5 Attachment J – Sample Early report letter





Shape6 8/6/2019

John Q. Public

Main St Anywhere US 12345

John Q. Public,

Recently, your child participated in the National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. You may recall that blood samples were collected as part of your examination on 7/1/2018. These samples were tested for mercury, a metal found in our environment. The test results reported below indicate your child has been exposed to mercury. A high blood level may result from eating large amounts of fish from waters containing high levels of mercury.


Your value

Elevated level *

Total Blood Mercury

9.5 ug/L

>= 5.8 ug/L

*Elevated levels are based on an EPA Reference Dose below which exposures among women of reproductive age are considered to be without adverse effects. From Rice DE, Schoeny R, Mahaffrey K. Methods and rationale for derivation of a reference dose for methyl mercury by the US Environmental Protection Agency. Risk Analysis. 2003; 23:107-115

We want to give you this important information about your child and urge you to have your child seen by their doctor because exposure to mercury at these levels may affect health. The NHANES program will not pay for any follow-up tests or care your child may require, but we will be available to talk with you or your doctor about this letter and to answer any questions you may have. You can reach me on one of our toll-free numbers below from 7:30 AM to 4:30 PM Eastern Time, Monday through Friday.

English:

1-800-452-6115, press "1"

Chinese:

1-866-887-7996, press "1"

Spanish:

1-800-452-6115, press "2"

Korean:

1-866-887-7996, press "2"


Sincerely,


Vietnamese:

1-866-887-7996, press "3"

Duong T. Nguyen, D.O.

Senior Medical Officer


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorStorandt, Renee (CDC/DDPHSS/NCHS/DHNES)
File Modified0000-00-00
File Created2021-01-14

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