Reporting Script for Clinical Tests

P_Att22_AdvReportScriptClinicalTests_20180802.docx

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)

Reporting Script for Clinical Tests

OMB: 0923-0061

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Pease Study

Advance Reporting Script Clinical Tests

Flesch-Kincaid Readability Score – 5.4

Attachment 22


Pease Study

Advance Reporting Script for Clinical Tests


HELLO,


My name is |_________________|. I am calling on behalf of the Agency for Toxic Substances and Disease Registry, or ATSDR for short. We are calling about the Pease Study. Am I speaking with |_NAME OF ADULT OR PARENT OF CHILD WHOSE RESULTS ARE CRITICAL_|?


[IF NOT CORRECT PERSON] Please let me know the best time we can reach [him/her].


|_________________| (day of the week)


|__|__|/|__|__|/|__|__| (date);


|__|__|:|__|__| AM PM (time).


I will call back then. Thank you.


[IF CORRECT PERSON] We are contacting you about [your/your child’s] lab results. [Your/Your child’s] [glucose/triglyceride/albumin/total bilirubin] test was significantly outside of the normal range. You should call [your/your child’s] doctor today to discuss this. We will be sending you a letter with the details of [your/your child’s] clinical tests.

Specifically, the results of [your/your child’s] test have shown the following [read those that apply.]

Do you have a pen or pencil to write this down?

  1. I am calling to report critical test results for |_NAME OF ADULT OR CHILD_|.

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    [Your/Your child’s] glucose level was |_________________| mg/dL. The test was performed on |__|__|/|__|__|/|__|__| (date).

    [If below 40 mg/dl read the following:] This is below the critical value of 40 mg/dL. [Your/Your child’s] diabetes was poorly controlled or [your/his/her] medications might need to be adjusted. If this problem has not been addressed, we recommend that [you/your child] see the doctor immediately.

    [If above 400 mg/dL read the following:] This is above the critical value of 400 mg/dL. [Your/Your child’s] blood sugar was very high.


    Select the appropriate critical test and reporting value from below:





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[Your/Your child’s] total bilirubin was |_________________| mg/dL. This is above the critical value of >12.9 mg/Dl. The test was performed on |__|__|/|__|__|/|__|__| (date).


[You/Your child] may have a liver problem or a bile duct problem.

[Your/Your child’s] albumin level was |_________________| g/dL. The test was performed on |__|__|/|__|__|/|__|__| (date).

[If below 1.5 g/dL read the following:] This is below the critical value of 1.5 g/dL. You may have a liver or kidney problem.

[If above 7.9 g/dL read the following:] This is above the critical level of 7.9 g/dL. You may be severely or chronically dehydrated.

[Your/Your child’s] triglyceride level was |_________________| mg/dL. This is above the critical value of 1,000 mg/dL. The test was performed on |__|__|/|__|__|/|__|__| (date).

[You have/Your child has] a problem with lipid metabolism and have very high risk of heart disease.

  1. As a check, please read back the participant name and [his/her] critical lab result to me. > Verbally correct any errors and repeat the request for a “read-back” to verify accurate reporting and message received.



  1. You should call [your/your child’s] doctor today to discuss this information. As it is now more than |__|__| months since we collected [your/your child’s] blood, this result may not be important today. You and [your/your child’s] doctor may have already taken steps to correct the problem. We will be sending you a letter with the details of [your/your child’s] clinical tests. If you or your doctor has a question about the results of these tests, you or he/she can contact us at ATSDR at [insert telephone number]. Thank you for [your/your child’s] participation in the study.


  1. [CONCLUSION] Document the date, time, test results, and person to whom the test results were reported. Prepare Attachment 22a – Advance Clinical Test Report Tracking Form and Attachment 22b - Letter Report of Critical Values for mailout.


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