Report of Findings

Attachment 1d

Form Approved

OMB No. 0920-0950

Exp. Date: 11/30/2021

Report of Findings - Example

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"

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.

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.

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

Attachment J – Sample Early report letter

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