MEC Examination Results

Attachment_11f_MEC_Examination_Results_2024JULY16.pdf

[NCHS] National Health and Nutrition Examination Survey (NHANES)

MEC Examination Results

OMB: 0920-0950

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Attachment 11f
MEC Examination Results

A. Final Report of Findings Sample ......................................................................................... 11f-2
B. Early Report of Findings Documentation .......................................................................... 11f-34

11f-A. Final Report of Findings Sample
A. Final Adult Report of Findings ............................................................................................ 11f-3
B. Final Minor Report of Findings ......................................................................................... 11f-15
C. Preliminary Adult Report of Findings ................................................................................ 11f-25
D. Preliminary Minor Report of Findings............................................................................... 11f-29

March 1, 2025

Ladonna Cooper
1234 Main Street
First, LA 70123

Dear Ladonna,
Thank you for taking part 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. We are
pleased to provide you with the results of your health exam from January 5, 2025. NHANES data are used
to evaluate the country’s health problems, develop health programs, and improve the quality of health care.
By taking part in this survey, you have helped add to our knowledge about the health status of people living
in the United States.
Your NHANES exam was not meant to be a complete assessment or replace visits to your health care
provider. However, your exam results may be useful for maintaining and improving your health, and you can
choose to share them with your health care providers.
Some of the NHANES exams and tests are usually done with people who have specific health problems.
Your results may show something abnormal but do not represent an illness. If you take your results to your
health care provider, they may recommend other tests that may or may not identify a health concern. You
will be responsible for any costs associated with these additional tests.
You are responsible for securing your test results. If you do not want anyone else to see your results, keep
them secure so no one else can review them. As described in the NHANES confidentiality agreement, we
will not report your results to health care providers or public health departments.
If you have any questions about the results of your exam, you can reach me Monday through Friday from 9
am to 5 pm Eastern Time, toll-free, at 1-800-452-6115 (press 1 for English and press 2 for Spanish).
Sincerely,

Duong Nguyen, DO
Captain, U.S. Public Health Service
Chief Medical Officer, Division of Health and Nutrition Examination Surveys
National Center for Health Statistics, Centers for Disease Control and Prevention
Enclosure
12345
{OMB NUMBER}
{OMB EXP DATE}

11f-3

Final Report of Findings
Date of Examination: January 25, 2025
Participant Name: Ladonna Cooper
Participant Age at Exam: 45 years

Participant Gender: Female
SP ID: 12345

Body Measurements
Your body measurements were
Weight

185 lbs 12 oz

Height

5 feet 7 inches

Body Mass Index

29 kg/m2

Waist Circumference 35.6 inches

Based on your gender and height, your weight is above the range
of a healthy weight, and you may be overweight.
Your waist circumference was greater than 35 inches. Based
on guidelines from the National Heart, Lung and Blood Institute
at NIH (1998) this is associated with an increased risk of health
problems such as type 2 diabetes, high blood pressure, and
cardiovascular disease.

For additional information on maintaining a healthy weight please see https://www.cdc.gov/
healthyweight/index.html.
Blood Pressure & Heart Rate
Your measurements were

Your blood pressure was elevated. Based on national
guidelines for the treatment of blood pressure,* your
blood pressure should be rechecked by your health
care provider within 3–6 months of the Mobile Exam
Center examination.

Systolic Blood Pressure: 131 mm/hg
Diastolic Blood Pressure: 82 mm/hg
Resting Pulse Rate: 88 Beats/ min

*Based on the American Cardiology Association (ACC) and the American Heart Association (AHA) Hypertension
Guidelines for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. American
Journal of Hypertension, 2018; 31(2):133-135.

For more information regarding preventing and managing high blood pressure see
https:// www.cdc.gov/bloodpressure/prevent_manage.html.
Visual Acuity
We have done a quick check of your vision. Our exam is not as precise as an eye exam done by an eye doctor.
These values may differ from a vision exam you may have by an ophthalmologist, optometrist, or optician.
Based on the examination, when wearing your glasses:
Your right eye distance vision is 20/40. Your left eye distance vision is 20/20.
This level of vision is below normal. If you were not already aware of this, you should follow up with your eye care
provider to have a full examination and determine whether your lens need to be adjusted to improve your vision.

These measurements were obtained as part of a survey and do not represent a medical diagnosis.
Interpretation of these measurements must be made by an appropriately licensed health care provider.
Ladonna Cooper 1/10/81, 1/25/25

11f-4

Final Report of Findings
Oral Health Exam
During the NHANES health exam, an oral health assessment was completed by a dental hygienist. The oral
health assessment of NHANES is not intended to be a substitute for the exam provided by your dentist or oral
health provider. The NHANES oral health assessment did not include a comprehensive dental history or x-rays.
The dental examiner recommends that you:

See a dentist within the next 2 weeks.

The dental examiner observed the following
conditions:

Decayed teeth/dental restoration issue.
Clinical impression of soft tissue condition.

For more information about maintaining your oral health see https://www.cdc.gov/oralhealth/ basics/
index.html.
Ophthalmology Exam
Digital images of the back of your eye, the retina, were taken during your NHANES exam. The eye examination
you received at the Mobile Exam Center was not a complete eye examination. Only a small portion of the
back of your eye, the retina, was photographed. Trained professionals evaluated the images but did not have
information about your vision, eye health, or general health status. You may already know the information
provided here. Trained professionals evaluated the images and found the following conditions.
Acute proliferative retinopathy: There were changes in the retina, the back of your eye, that are often found in
people with diabetes. These changes were found in the right eye.
If you are not currently under the care of an eye doctor (ophthalmologist) for this, you should make an
appointment immediately to have this condition evaluated.
Suspicious cup/disc ratio: The optic nerve (the main nerve going into the eye) in the left eye has changes that
suggest glaucoma may be present.
If you have not already or are not currently under the care of an eye doctor (ophthalmologist) for this, you
should make an appointment immediately.
Nevus present without concerning features: A choroidal nevus, a small mole, like a birthmark, was found in the
back of your right eye.
This should be watched annually by your eye doctor (ophthalmologist).

For more information about maintaining your vision and eye health see https://www.cdc.gov/
visionhealth/.

11f-5

Final Report of Findings
Audiometry Acuity

The test indicates mild hearing loss in the low frequencies and a
moderate hearing loss in the high frequencies.
Left Ear
The test indicates moderate hearing loss across most test frequencies.
The softest sounds you are able to hear are called hearing thresholds. Your thresholds at different
frequencies (pitches) are reported in the table below. The lower-pitched sounds are toward the left of
the table and the higher-pitched sounds are toward the right. Smaller numbers mean quieter sounds
and therefore indicate better hearing. Values of 25 dB or less are considered normal hearing for adults.
Right Ear

Hearing Levels by Ear and Frequency (Air Conduction) per dB HL

Frequency (Hz) 500
1,000
2,000
3,000
4,000
6,000
8,000
Right Ear
40
45
50
50
60
60
70
Left Ear
45
40
50
50
50
50
50
This kind of hearing loss could cause you to have difficulty hearing speech.
The audiometry test can identify a hearing problem but cannot determine the cause of hearing loss.
It is recommended that you see a health care provider regarding your hearing loss if you have not
already done so.
Lung Function Testing
This test was done to know how well your lungs work by measuring how much air you breathed in, how much
air you breathed out, and how quickly you breathed it out. Trained professionals evaluated your lung function
test but did not have information about your lung health or general health status.
Lung function testing was done using the Easy on-PC spirometer. The results below are based on the highest
values among all your efforts.
Compared with other people of your age, sex, and height, your breathing test results were within normal limits.*
Measure

Best

LLN

z-score

% Pred

FVC (L)

5.4

4.96

-0.91

FEV1 (L)

4.4

4.11

-1.06

FEV1/FVC

81.5

74.3

-0.42

FET (s)

3.1

FVC – forced vital capacity; FEV1 – forced expiratory volume in 1 second; FET – forced expiratory time; LLN –
lower limit of normal; z-score – statistic describing how far the best value deviates from the predicted value; %
Pred – percent of the predicted value.
Reference values used to calculate LLN, z-score, and % Predicted are based on the Global Lung Function
Initiative (GLI) Global reference equation.
* Based on Bowerman C, Bhakta NR, Brazzale D, et al. A Race-neutral Approach to the Interpretation of
Lung Function Measurements. Am J Respir Crit Care Med. 2023;207(6):768-774.

For more information on maintaining healthy lungs see https://www.cdc.gov/asthma/ community-health/.
4

11f-6

Final Report of Findings
Bone Mineral Density Measurements
The bone density measurement can help spot persons who may be at greater risk for fracture because they
have weaker bones. In general, a lower bone density means that the bone is weaker. Yet not all men or women
with low bone density will have fractures.
The results of
your left hip
scan show hip
bone density
0.767 g/cm2.

This equals a
T-score of -1.2.

Based on diagnostic criteria as
recommended by the World Health
Organization and the International
Society of Clinical Densitometry
(International Society for Clinical
Densitometry, 2023) your hip bone
density is low.

The results from This equals a
your spine scan T-score of -0.7.
show spine
bone density
1.019 g/cm2.

Based on diagnostic criteria as
recommended by the World Health
Organization and the International
Society of Clinical Densitometry
your spine bone density is normal.

Most people develop low bone
density over many years. We
recommend you discuss these results
with your health care provider. Your
provider can review your diet and
lifestyle and tell you what you can do
to prevent more bone loss.

For additional information on maintaining your bone health please see https://www.nia.nih.gov/health/
osteoporosis.
Complete Blood Count
Test

Result

Units

3.7

x1012/L

Hematocrit

Low

32-45.9

Hemoglobin

g/dL

Low

10.6-15.6

Red Blood Count (RBC)

Flag

Reference Range
3.5-5.34

Mean Corpuscular Volume (MCV)

88.2

74.6-98.2

Mean Corpuscular Hemoglobin (MCH)

27.0

24.3-33.8

MCH Concentration (MCHC)

33.1

g/dL

32.1-35.3

Red Cell Distribution Width (RDW)

15.1

11.4-16.3

White Blood Count (WBC)

9.2

x10 /L

4-11.6

Absolute Lymphocytes

4.2

x10 /L

0.6-6.1

Absolute Monocytes

7.2

x109/L

3.8-11.6

Absolute Neutrophils

1.0

x109/L

0.2-1.5

Absolute Eosinophils

0.5

x10 /L

0.0-0.9

Absolute Basophils*

0.1

x10 /L

0.0-0.2

9
9

Lymphocytes Percentage

15.1

14.1-47.6

Monocytes Percentage

4.2

3.8-11.6

Neutrophils Percentage

55.1

40.9-78.1

Eosinophils Percentage

6.3

0.6-7.3

Basophils Percentage*

1.7

0.1-2.5
5

11f-7

Final Report of Findings
Complete Blood Count
Test

Result

Units

Flag

Reference Range

Platelet Count

x10 /L

39.8-78.1

Mean Platelet Volume (MPV)

8.2

6.8-10.2

---Test not done
Please follow up with a health care provider for Complete Blood Count.
*This finding was not confirmed by microscopy and follow-up may be necessary.
Diabetes Blood Test
Test

Result

Units

Flag

Reference Range

Glucose

132

mg/dL

High

60-109

Hemoglobin A1c

6.1

< 6.5

Glucose (high): Please follow up with your health care provider
For more information about diabetes see https://www.cdc.gov/diabetes/basics/diabetes.html.
Thyroid Function Tests
Result

Units

Total Thyroxine (Total T4)

Test

149

nmol/L

Flag

Reference Range
58-151

Free Thyroxine (Free (T4)

1.70

ng/dl

0.93-1.73

Thyroid Peroxidase Antibodies

IU/mL

<34

Thyroglobulin Antibodies

110

IU/mL

<116

Thyroid Stimulating Hormone (TSH)

0.23

mIU/mL

Low

0.51-5

Thyroid Stimulating Hormone Receptor
Antibodies (TSRAb)

0.65

IU/mL

High

<0.54

TSH (Low): Please follow up with your health care provider
TSRAb (High): Please follow up with your health care provider
For more information about maintaining thyroid health see
https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism or
https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism.
Kidney Function Tests
Test

Result

Units

BUN

mg/dL

Creatinine

1.0

mg/dL

Estimated Glomerulus Filtration Rate (eGFR)

mL/min/ 1.73m

Albumin Creatinine Ratio (Urine)

mg/g

Flag

Reference Range
6-19
0.4-1.2

<60.00
< 30.00

For more information about maintaining kidney health see https://www.cdc.gov/kidneydisease/index.html.

11f-8

Final Report of Findings
Liver Function Tests
Test

Result

Units

Flag

Reference Range

Alanine Aminotransferase (ALT)

IU/L

< 31

Albumin

4.0

g/dL

3.2-5.2

Alkaline Phosphatase

IU/L

39-117

Aspartate Aminotransferase (AST)

IU/L

< 31

0.45

mg/dL

0.0-1.0

Gamma Glutamyl Transaminase (GGT)

IU/L

7-33

Lactate Dehydrogenase (LDH)

123

IU/L

94-250

Result

Units

Flag

Reference Range

Cholesterol

210

mg/dL

High

< 200

HDL

mg/dL

Triglycerides

173

mg/dL

High

< 150

LDL Calculated

152

mg/dL

High

< 130

Total Bilirubin

Cholesterol and Lipid Tests
Test

> 39

Cholesterol (High): Please follow up with your health care provider
Triglycerides (High): Please follow up with your health care provider
LDL Calculated (High): Please follow up with your health care provider
For more information about maintaining healthy cholesterol and lipid levels see https://www.cdc.gov/
cholesterol/index.htm.
Hemoglobin Variants
Test

Result

Flag

Reference Range

Hemoglobin variant (S)

Not Present

Hemoglobin variant (C)

Not Present

Hemoglobin variant (D)

Not Present

Hemoglobin variant (F)

Not Present

Hemoglobin variant (E)

Not Present

Hepatitis Profile
Test

Result

Flag

Reference Range

Hepatitis B surface Antigen (HbsAg)

Nonreactive

Hepatitis C Antibodies (HCV-Ab)

Nonreactive

Allergy Testing
Test

Result

Units

Flag

Reference Range

Total IgE

Ku/L

>100

alpha-gal

0.44

Ku/L

>0.35

Alternaria alternata (mold)

0.21

Ku/L

<0.35

Ambrosia artemisilfolia (ragwood short/ common)

0.01

Ku/L

<0.35
7

11f-9

Final Report of Findings
Allergy Testing
Test

Result

Units

Flag

Reference Range

Aspergillus fumigatus (mold)

0.33

Ku/L

<0.35

Bermuda grass

0.27

Ku/L

<0.35

Birch

0.23

Ku/L

<0.35

Cat epithelium and dander

0.27

Ku/L

<0.35

Cladosporium herbarum

0.12

Ku/L

<0.35

Common ragweed

0.20

Ku/L

>0.35

Cows Milk

0.01

Ku/L

<0.35

D. farinae (dust mite)

0.21

Ku/L

<0.35

D. pteronyssinus (dust mite)

0.16

Ku/L

<0.35

Dog dander

0.33

Ku/L

<0.35

Egg

0.05

Ku/L

<0.35

Blatella Germanica (German cockroach)

0.33

Ku/L

<0.35

Mouse urine proteins

0.23

Ku/L

<0.35

Peanut

0.03

Ku/L

<0.35

Penicillium

0.44

Ku/L

>0.35

Russian thistle

0.26

Ku/L

<0.35

Shellfish (shrimp)

0.02

Ku/L

<0.35

White Oak

0.17

Ku/L

<0.35

---Test not done
The results in this table do not confirm if you do or do not have an allergy to the items tested. For an allergy to be
appropriately diagnosed, a healthcare provider must interpret these results with a medical history and other medical
information.

Iron Profile Tests
Test
Serum Ferritin

Result

Units

µg/L

Flag

Reference Range
15-150

Folate in Red Blood Cells

740

nmol/L

640-2006

Folate in Serum

12.3

nmol/L

10.5-90.7

µg/dL

22-163

Iron
Reproductive Hormones
Test

Result

Units

17α-Hydroxyprogesterone

ng/dL

Varies individually

Androstenedione

ng/dL

85-275

Anti-Mullerian Hormone

Flag

Reference Range

1.01

ng/dL

0.06-4.44

Dehydroepiandrosterone Sulfate (DHEAS)

µg/mL

Varies individually

Estrone

ng/mL

Varies individually

Estrone Sulfate

880

pg/mL

Varies individually

Estradiol

210

pg/mL

Varies individually

11f-10

Final Report of Findings
Iron Profile Tests
Test

Result

Units

Flag

Reference Range

Sex Hormone Binding Protein (SHBP)

nmol/L

Varies individually

Follicle Stimulating Hormone

mIU/mL

< 8.5

Luteinizing Hormone

mIU/mL

5-25

Testosterone

ng/dL

9-55

Reproductive hormone testing is used in medical settings to help diagnose and follow conditions such as infertility,
early or delayed puberty, and menstrual irregularities. Some reproductive hormone levels vary among individuals or
depending on the time of day that samples were taken and the phase of menstrual cycles. Results that are lower or
higher than the Reference Range are not always associated with illnesses or health risks. Please review these results
with your healthcare provider.

Other Blood Chemistry Tests
Test

Result

Units

Flag

Reference Range

Bicarbonate

mmol/L

22-29

Calcium

9.2

mg/dL

8.4-10.2

Chloride

102

mmol/L

96-108

Magnesium

1.9

mg/dL

>1.6

Potassium

4.1

mmol/L

3.30-5.10

Total Protein

6.1

g/dL

5.9-8.4

Sodium

141

mmol/L

133-145

CPK

167

IU/L

22-199

Result

Units

nmol/L

Additional Tests
Test
Vitamin D
Urine Pregnancy

Flag

Reference Range
30-125

Negative

Number of hours fasted prior to blood draw

8.5

---Test not done
Environmental Health Profile
Blood Test

Result

Units

Flag

Reference Range

Butyrylcholinesterase activity & concentration

0.1

U/ml

≥0.05

Cadmium

0.5

µg/L

0.3-1.2

11f-11

Final Report of Findings
Environmental Health Profile
Blood Test

Result

Units

0.2

µg/dL

<10

µg/L

4-15

Total Mercury

1.1

µg/L

<5.7

Selenium

µg/L

58-234

Result

Units

Urinary Arsenic/ Speciated Arsenic

µg/L

<50

Urinary Chromium

0.3

µg/L

<10

Lead
Manganese

Urine Test

Urinary Nickel
Household Water
Fluoride, water

1.3

µg/L

Result

Units

0.9

mg/L

Flag

Reference Range

{1-3}
Flag

Reference Range
0.7-1.2

---Test not done

For more information about Environmental Exposures and your health see
• https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.aspx?faqid=19&toxid=3
• https://www.cdc.gov/fluoridation/basics/index.htm
• https://www.cdc.gov/biomonitoring/pdf/Cadmium_FactSheet.pdf
• https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.aspx?faqid=47&toxid=15
• https://www.cdc.gov/biomonitoring/Mercury_FactSheet.html or
• https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.aspx?faqid=113&toxid=24
• https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.aspx?faqid=93&toxid=22

11f-12

Final Report of Findings
Laboratory Information
The following CLIA-certified laboratories performed the named tests on biologic specimens.
NHANES Mobile Examination Center Laboratory
National Center for Health Statistics
3311 Toledo Road
Hyattsville, MD 20782

Complete blood count

CDC/NCID Division of Viral Hepatitis
1600 Clifton Road NE
Building 18, Floor/Room 3-218, MS A33
Atlanta, GA 30329

Hepatitis B surface antigen, Hepatitis C RNA and
genotype, and Hepatitis D

Diabetes Diagnostic Laboratory University
of Missouri - Columbia Hospital Drive Room M765
Columbia, MO 65212

Glucose, hemoglobin A1c and Hemoglobin variants:
C, D, E, F, and S

Urine pregnancy (via the Beckman Coulter ICON 25 hCG
urinary pregnancy test)

(This contract will need to be rebid for 2025.)
University of Minnesota
Advanced Research and Diagnostic Laboratory
1200 Washington Ave S Suite 175
Minneapolis, MN 55415
(This contract will need to be rebid for 2025.)

Blood Tests – Chemistry Panel:
(ALT, AST, Albumin, Alkaline phosphatase (ALP),
Bicarbonate, Bilirubin, BUN, Calcium, Chloride,
Creatinine (serum), Cystatin C, Estimated glomerular
filtration rate (EGFR), GGT, Glucose, Iron, Lactate
Dehydrogenase (LDH), Magnesium, Potassium, Sodium,
Total bilirubin, Total protein, Uric acid)
Lipid Panel: Cholesterol, HDL, LDL, and Triglycerides
Urine Tests: Albumin/creatinine ratio

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

RBC folate, Serum ferritin, Serum folate, Vitamin D

Centers for Disease Control and Prevention
National Center for Environmental Health/DLS/CCB
Chamblee Bldg 110 Rm 2112m MS S110-2
Atlanta, GA 30341

Reproductive hormones: Androstenedione,
dehydroepiandrosterone, Anti-mullerian hormone
(females only), Estradiol, Estrone, Estrone sulfate, Follicle
stimulating hormone (FSH), Hydroxyprogesterone,
Luteinizing hormone (LH), Progesterone, Sex-hormone
binding globulin, and Testosterone
Thyroid panel: Free and total triiodothyronine (T3), free
and total thyroxine (T4), thyroid stimulating hormone
(TSH), thyroglobulin antibodies, thyroid peroxidase
antibodies (TPO), thyroglobulin, thyroid stimulating
hormone receptor antibodies

11f-13

Final Report of Findings
Laboratory Information
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations include federal standards
applicable to all U.S. facilities or sites that test human specimens for health assessment or to diagnose,
prevent, or treat disease.
The following CLIA-certified laboratories performed the named tests on biologic specimens.
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

Blood Tests: Cadmium, Inorganic mercury Lead,
Manganese, Selenium, Total mercury

Centers for Disease Control and Prevention
NCEH/DLS/ERB
CHAMBLEE BLDG 110 Rm 4112L MS S110-4
Atlanta, GA 30341

Butyrylcholinesterase activity

TBD
{Lab Name}Diabetes Diagnostic {Lab Title}
{Lab Location}
{Lab Street Address}
{Lab Street Address 2}
{Lab City State Zip}

Allergy Testing

Urine Tests: Chromium, Nickel & Total arsenic
Other samples: Water fluoride

11f-14

May 25, 2025

William Cooper
1234 Main Street
First, LA 70123
To the Parent or Guardian of William Cooper,
Thank you for helping William take part 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.
We are pleased to provide you William’s results of their health exam from January 25, 2025. NHANES data are
used to evaluate the country’s health problems, develop health programs, improve the quality of health care, and
help add to our knowledge about the health status of people living in the United States.
William’s NHANES exam was not meant to be a complete assessment or replace visits to their health care
provider. However, their exam results may be useful for maintaining and improving their health, and you can
choose to share them with William’s health care providers.
Some of the NHANES exams and tests are usually done with people who have specific health problems.
William’s results may show something abnormal but do not represent an illness. If you take William’s results
to William’s health care provider, they may recommend other tests that may or may not identify a health
concern. You will be responsible for any costs associated with these additional tests.
You are responsible for securing William’s test results. If you do not want anyone else to see their results,
keep them secure so no one else can review them. As described in the NHANES confidentiality agreement,
we will not report these results to health care providers or public health departments.
If you have any questions about the results of William’s exam, you can reach me toll-free Monday through
Friday from 9 am to 5 pm Eastern Time at 1-800-452-6115 (press 1 for English and press 2 for Spanish).
Sincerely,

11f-15

Final Report of Findings
Date of Examination: January 25, 2025
Participant Name: William Cooper
Participant Age at Exam: 8 years

Participant Gender: Male
SP ID: 12345

Body Measurements
William’s body measurements were
Weight

110 lbs 9 oz

Height

4 feet 10 inches

Body Mass Index

23 kg/m2

Based on the 2000 CDC BMI-for-age growth chart curves for
boys and girls, considering William’s age, gender and height, their
weight is above the range of a healthy weight, and William may
have obesity.

Waist Circumference 32.6 inches

For additional information about child and teen BMI, please see: https://www.cdc.gov/nutrition/.
Blood Pressure & Heart Rate
William’s measurements were

William’s blood pressure was elevated. Based on
national guidelines for the treatment of hypertension,
the blood pressure should have been rechecked by
a health care provider within 6 months of the Mobile
Exam Center examination.*

Systolic Blood Pressure: 1114 mm/hg
Diastolic Blood Pressure: 62 mm/hg
Resting Pulse Rate: 88 Beats/ min

*Based on the Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children
and Adolescents Subcommittee on screening and Management of High Blood Pressure in children. Pediatrics.
2017;140(3) e201071904

For additional information about means to prevent and managing high blood pressure, please see:
https://www.cdc.gov/bloodpressure/prevent_manage.html.
Visual Acuity
We have done a quick check of William’s vision. Our exam is not as precise as an eye exam done by an eye
doctor. These values may differ from a vision exam William may have had by an ophthalmologist, optometrist,
or optician.
Based on the examination, when wearing your glasses:
William’s right eye distance vision is 20/30.William’s’s left eye distance vision is 20/25.
This level of vision is below normal. If you were not previously aware of this, and have not done so already,
William should follow up with their health or eye care provider to have a full examination and perhaps improve
their vision.

For additional information about visual acuity, please see: https://www.cdc.gov/visionhealth/.

11f-16

See a dentist within the next 2 weeks.

The dental examiner observed the following
conditions:

Decayed teeth/dental restoration issue.
Clinical impression of soft tissue condition.

For more information about maintaining your oral health see https://www.cdc.gov/oralhealth/ basics/
index.html.
Lung Function Testing
This test was done to know how well William’s lungs work by measuring how much air they breathed in, how
much air they breathed out and how quickly they breathed it out. Trained professionals evaluated William’s
lung function test but did not have information about their lung health or general health status. Lung function
testing was done using the Easy on-PC spirometer. The results below are based on the highest values among
all William’s efforts.
Compared with other people of William’s age, sex, and height, their breathing test results were within normal
limits.*
Measure

Best

LLN

z-score

% Pred

FVC (L)

1.80

1.56

-0.84

87.7

FEV1 (L)

1.71

1.4

-0.41

94.2

FEV1/FVC

79.3

0.99

106.6

FET (s)

2.2

FVC – forced vital capacity; FEV1 – forced expiratory volume in 1 second; FET – forced expiratory time; LLN –
lower limit of normal; z-score – statistic describing how far the best value deviates from the predicted value;
% Pred – percent of the predicted value.
Reference values used to calculate LLN, z-score, and % Predicted are based on the Global Lung Function
Initiative (GLI) Global reference equation.
* Based on Bowerman C, Bhakta NR, Brazzale D, et al. A Race-neutral Approach to the Interpretation of Lung
Function Measurements. Am J Respir Crit Care Med. 2023;207(6):768-774.

For more information on maintaining healthy lungs see https://www.cdc.gov/asthma/ community-health/.

11f-17

Final Report of Findings
Audiometry Acuity
Right Ear

The test indicates normal low frequencies hearing and a mild high frequency hearing loss.

Left Ear

The test indicates normal low frequencies hearing and a mild high frequency hearing loss.

The softest sounds William is able to hear are called hearing thresholds. William’s thresholds at different
frequencies (pitches) are reported in the table below. The lower-pitched sounds are toward the left of the table
and the higher-pitched sounds are toward the right. Smaller numbers mean quieter sounds and therefore
indicate better hearing. Values of 20 dB or less are considered normal hearing for children.
Hearing Levels by Ear and Frequency (Air Conduction) per dB HL
Frequency
(Hz)

500

1,000

2,000

3,000

4,000

6,000

8,000

Right Ear

Left Ear

The audiometry test can identify a hearing problem but cannot determine the cause of hearing loss.
This kind of hearing loss could cause your child to miss some speech sounds to have difficulty hearing speech.
It is recommended that William sees a health care provider regarding their hearing loss if they have not already
done so.

For additional information on maintaining hearing, please see https://www.cdc.gov/hearingloss/
default.html.
Complete Blood Count
Test
Red Blood Count (RBC)

Result

Units

3.7

x10 /L

Flag

Reference Range
3.5-5.34

Hematocrit

Low

32-45.9

Hemoglobin

g/dL

Low

10.6-15.6

Mean Corpuscular Volume (MCV)

88.2

74.6-98.2

Mean Corpuscular Hemoglobin (MCH)

27.0

24.3-33.8

MCH Concentration (MCHC)

33.1

g/dL

32.1-35.3

Red Cell Distribution Width (RDW)

15.1

11.4-16.3

White Blood Count (WBC)

9.2

x109/L

4-11.6

Absolute Lymphocytes

4.2

x10 /L

0.6-6.1

Absolute Monocytes

7.2

x10 /L

3.8-11.6

Absolute Neutrophils

1.0

x10 /L

0.2-1.5

Absolute Eosinophils

0.5

x109/L

0.0-0.9

Absolute Basophils*

0.1

x10 /L

0.0-0.2

Lymphocytes Percentage

15.1

14.1-47.6

Monocytes Percentage

4.2

3.8-11.6

Neutrophils Percentage

55.1

40.9-78.1

Eosinophils Percentage

6.3

0.6-7.3

9
9
9

11f-18

Final Report of Findings
Complete Blood Count
Test

Result

Units

1.7

0.1-2.5

Platelet Count

x10 /L

39.8-78.1

Mean Platelet Volume (MPV)

8.2

6.8-10.2

Basophils Percentage*

Flag

Reference Range

---Test not done
Please follow up with a health care provider for Complete Blood Count.
*This finding was not confirmed by microscopy and follow-up may be necessary.
Thyroid Function Tests
Result

Units

Total Thyroxine (Total T4)

Test

149

nmol/L

Flag

58-151

Free Thyroxine (Free (T4)

1.70

ng/dl

1.04-1.87

Thyroid Peroxidase Antibodies

IU/mL

<34

Thyroglobulin Antibodies

110

IU/mL

<116

Thyroid Stimulating Hormone (TSH)

0.83

mIU/mL

0.55-5.31

Thyroid Stimulating Hormone Receptor
Antibodies (TSRAb)

0.65

IU/mL

High

Reference Range

<0.54

For more information about maintaining thyroid health see
https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism or
https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism.
Kidney Function Tests
Test
Albumin Creatinine Ratio (Urine)

Result

Units

mg/g

Flag

Reference Range
< 30.00

For more information about maintaining kidney health see https://www.cdc.gov/kidneydisease/index.html.
Hepatitis Profile
Test

Result

Flag

Reference Range

Hepatitis B surface Antigen (HbsAg)

Nonreactive

Hepatitis C Antibodies (HCV-Ab)

Nonreactive

11f-19

Final Report of Findings
Cholesterol and Lipid Tests
Test

Result

Units

Flag

Reference Range

HDL

mg/dL

Triglycerides

153

mg/dL

High

< 150

LDL Calculated

120

mg/dL

High

< 110

> 39

Cholesterol (High): Please follow up with William’s health care provider
Triglycerides (High): Please follow up with William’s health care provider
LDL Calculated (High): Please follow up with William’s health care provider
For more information about maintaining healthy cholesterol and lipid levels see https://www.cdc.gov/
cholesterol/index.htm.
Allergy Testing
Test

Result

Units

Flag

Reference Range

Total IgE

Ku/L

>100

alpha-gal

0.44

Ku/L

>0.35

Alternaria alternata (mold)

0.21

Ku/L

<0.35

Ambrosia artemisilfolia (ragwood short/ common)

0.01

Ku/L

<0.35

Aspergillus fumigatus (mold)

0.37

Ku/L

High

<0.35

Bermuda grass

0.56

Ku/L

High

<0.35

Birch

0.23

Ku/L

Cat epithelium and dander

0.76

Ku/L

Cladosporium herbarum

0.12

Ku/L

<0.35

Common ragweed

0.20

Ku/L

>0.35

Cows Milk

0.01

Ku/L

<0.35

D. farinae (dust mite)

0.21

Ku/L

<0.35

D. pteronyssinus (dust mite)

0.16

Ku/L

<0.35

Dog dander

0.33

Ku/L

<0.35

Egg

0.68

Ku/L

Blatella Germanica (German cockroach)

0.33

Ku/L

<0.35

Mouse urine proteins

0.23

Ku/L

<0.35

<0.35
High

High

<0.35

11f-20

Final Report of Findings
Allergy Testing
Test

Result

Units

Flag

Reference Range

Peanut

0.03

Ku/L

<0.35

Penicillium

0.44

Ku/L

>0.35

Russian thistle

0.26

Ku/L

<0.35

Shellfish (shrimp)

0.02

Ku/L

<0.35

White Oak

0.17

Ku/L

<0.35

---Test not done
The results in this table do not confirm if William does or does not have an allergy to the items tested.
For an allergy to be appropriately diagnosed, a healthcare provider must interpret these results with a medical
history and other medical information.
Reproductive Hormones
Test

Result

Units

Flag

17α-Hydroxyprogesterone

ng/dL

<90

Androstenedione

ng/dL

Varies individually

Dehydroepiandrosterone Sulfate (DHEAS)

µg/mL

Varies individually

Estrone

ng/mL

Varies individually

Estrone Sulfate

880

pg/mL

Varies individually

Estradiol

210

pg/mL

Varies individually

Sex Hormone Binding Protein (SHBP)

nmol/L

Varies individually

Follicle Stimulating Hormone

mIU/m

Varies individually

Luteinizing Hormone

mIU/m

1.7-8.6

Testosterone

ng/dL

High

Reference Range

Reproductive hormone testing is used in medical settings to help diagnose and follow conditions such as
infertility, early or delayed puberty, and menstrual irregularities. Some reproductive hormone levels vary among
individuals or depending on the time of day that samples were taken and the phase of menstrual cycles.
Results that are lower or higher than the Reference Range are not always associated with illnesses or health
risks. Please review these results with your health care provider.
Testosterone (High): Please follow up with William’s health care provider
Additional Tests
Test

Result

Units

nmol/L

Vitamin D
Number of hours fasted prior to blood draw

Flag

Reference Range
30-125

8.5

---Test not done
Environmental Health Profile
Blood Test
Butyrylcholinesterase activity & concentration

Result

Units

0.1

U/ml

Flag

Reference Range
≥0.05
7

11f-21

Final Report of Findings
Environmental Health Profile
Blood Test

Result

Units

Cadmium

0.5

µg/L

0.3-1.2

Lead

0.2

µg/dL

<10

Manganese

Flag

Reference Range

µg/L

4-15

Total Mercury

1.1

µg/L

<5.7

Selenium

µg/L

58-234

Result

Units

Urinary Arsenic/ Speciated Arsenic

µg/L

Urinary Chromium

0.3

µg/L

<10

Urinary Nickel

1.3

µg/L

{1-3}

Result

Units

0.9

mg/L

Urine Test

Household Water
Fluoride, water

Flag

Reference Range
<50

Flag

Reference Range
0.7-1.2

---Test not done

11f-22

Complete blood count

CDC/NCID Division of Viral Hepatitis
1600 Clifton Road NE
Building 18, Floor/Room 3-218, MS A33
Atlanta, GA 30329

Hepatitis B surface antigen, Hepatitis C RNA and
genotype, and Hepatitis D

Diabetes Diagnostic Laboratory University
of Missouri - Columbia Hospital Drive Room M765
Columbia, MO 65212

Glucose, hemoglobin A1c and Hemoglobin variants:
C, D, E, F, and S

Urine pregnancy (via the Beckman Coulter ICON 25 hCG
urinary pregnancy test)

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

RBC folate, Serum ferritin, Serum folate, Vitamin D

Centers for Disease Control and Prevention
National Center for Environmental Health/DLS/CCB
Chamblee Bldg 110 Rm 2112m MS S110-2
Atlanta, GA 30341

11f-23

Blood Tests: Cadmium, Inorganic mercury Lead,
Manganese, Selenium, Total mercury

Centers for Disease Control and Prevention
NCEH/DLS/ERB
CHAMBLEE BLDG 110 Rm 4112L MS S110-4
Atlanta, GA 30341

Butyrylcholinesterase activity

TBD
{Lab Name}Diabetes Diagnostic {Lab Title}
{Lab Location}
{Lab Street Address}
{Lab Street Address 2}
{Lab City State Zip}

Allergy Testing

Urine Tests: Chromium, Nickel & Total arsenic
Other samples: Water fluoride

11f-24

March 1, 2025

Ladonna Cooper
1234 Main Street
First, LA 70123

Dear Ladonna,
The results of the tests you completed during your visit to the Mobile Exam Center on January 5,
2025 are attached. These are your initial laboratory results. You will receive a final report of your exam
findings in 3 to 4 months. These exams are not intended to be a complete health exam or replace
visits to your health care provider.
Some of the NHANES exams and tests are usually done with people who have specific health
problems. Your results may show something abnormal but do not represent an illness. If you take your
results to your health care provider, they may recommend other tests that may or may not identify
a health concern. You will be responsible for any costs associated with these additional tests.
You are responsible for securing your test results. If you do not want anyone else to see your results,
keep them secure so no one else can review them. As promised in our confidentiality agreement, we
do not report these results to health care providers or to public health departments.
If you have any questions regarding your results, please feel free to contact me toll-free between 9
am and 5 pm Eastern Time, Monday through Friday, at 1-800-452-6115 6115 (press 1 for English and
press 2 for Spanish).
Sincerely,

11f-25

Preliminary Report of Findings
Date of Examination: January 25, 2025
Participant Name: Ladonna Cooper
Participant Age at Exam: 44 years

Participant Gender: Female
SP ID: 12345

Body Measurements
Your body measurements were
Weight

185 lbs 12 oz

Height

5 feet 7 inches

Body Mass Index

29 kg/m2

Waist Circumference 35.6 inches

For additional information on maintaining a healthy weight please see https://www.cdc.gov/
healthyweight/index.html.
Blood Pressure & Heart Rate
Your measurements were

Your blood pressure was elevated. Based on national
guidelines for the treatment of blood pressure,* your
blood pressure should have been rechecked by your
health care provider within 3–6 months of the Mobile
Exam Center examination.

Systolic Blood Pressure: 131 mm/hg
Diastolic Blood Pressure: 82 mm/hg
Resting Pulse Rate: 88 Beats/ min

11f-26

Preliminary Report of Findings
Oral Health Exam
During the NHANES health exam, an oral health assessment was completed by a dental hygienist. The oral
health assessment of NHANES is not intended to be a substitute for the exam provided by your dentist or oral
health provider. The NHANES oral health assessment did not include a comprehensive dental history or x-rays.
The dental examiner recommends that you:

See a dentist within the next 2 weeks.

The dental examiner observed the following
conditions:

Decayed teeth/dental restoration issue.
Clinical impression of soft tissue condition.

For more information about maintaining your oral health see https://www.cdc.gov/oralhealth/ basics/
index.html.
Audiometry Acuity
Right Ear

The test indicates mild hearing loss in the low frequencies and a moderate hearing loss in the
high frequencies.

Left Ear

The test indicates moderate hearing loss across most test frequencies.

The softest sounds you are able to hear are called hearing thresholds. Your thresholds at different frequencies
(pitches) are reported in the table below. The lower-pitched sounds are toward the left of the table and the
higher-pitched sounds are toward the right. Smaller numbers mean quieter sounds and therefore indicate
better hearing. Values of 25 dB or less are considered normal hearing for adults.
Hearing Levels by Ear and Frequency (Air Conduction) per dB HL
Frequency (Hz) 500

1,000

2,000

3,000

4,000

6,000

8,000

Right Ear

Left Ear

This kind of hearing loss could cause you to have difficulty hearing speech.
The audiometry test can identify a hearing problem but cannot determine the cause of hearing loss.
It is recommended that you see a health care provider regarding your hearing loss if you have not already done
so.

For more information about maintaining hearing health see https://www.cdc.gov/hearingloss/default.html
Complete Blood Count
Test

Units

3.7

x1012/L

Hematocrit

Low

32-45.9

Hemoglobin

g/dL

Low

10.6-15.6

88.2

Red Blood Count (RBC)

Mean Corpuscular Volume (MCV)

Flag

Reference
Range

Result

3.5-5.34

74.6-98.2

Mean Corpuscular Hemoglobin (MCH)

27.0

24.3-33.8

MCH Concentration (MCHC)

33.1

g/dL

32.1-35.3

Red Cell Distribution Width (RDW)

15.1

11.4-16.3

11f-27

Preliminary Report of Findings
Complete Blood Count
Test

Flag

Reference
Range

Result

Units

White Blood Count (WBC)

9.2

x109/L

4-11.6

Absolute Lymphocytes

4.2

x10 /L

0.6-6.1

Absolute Monocytes

7.2

x10 /L

3.8-11.6

Absolute Neutrophils

1.0

x109/L

0.2-1.5

Absolute Eosinophils

0.5

x10 /L

0.0-0.9

Absolute Basophils*

0.1

x10 /L

0.0-0.2

Lymphocytes Percentage

15.1

14.1-47.6

9
9

Monocytes Percentage

4.2

3.8-11.6

Neutrophils Percentage

55.1

40.9-78.1

Eosinophils Percentage

6.3

0.6-7.3

Basophils Percentage*

1.7

0.1-2.5

Platelet Count

x10 /L

39.8-78.1

Mean Platelet Volume (MPV)

8.2

6.8-10.2

---Test not done
Please follow up with a health care provider for Complete Blood Count.
*This finding was not confirmed by microscopy and follow-up may be necessary.
Additional Tests
Test

Result

Urine Pregnancy

Negative

Flag

Reference Range

--Test not done

Laboratory Information
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations include federal standards
applicable to all U.S. facilities or sites that test human specimens for health assessment or to diagnose,
prevent, or treat disease.
The following CLIA-certified laboratories performed the named tests on biologic specimens.
NHANES Mobile Examination Center Laboratory
National Center for Health Statistics
3311 Toledo Road
Hyattsville, MD 20782

Complete blood count
Urine pregnancy (via the Beckman Coulter ICON 25 hCG
urinary pregnancy test)

11f-28

January 25, 2025

William Cooper
1234 Main Street
First, LA 70123

To the Parent or Guardian of William Cooper,
The results of the tests William completed during their visit to the Mobile Exam Center on January
25, 2025 are attached. These are William’s initial laboratory results. You will receive a final report of
William’s exam findings in 3 to 4 months. These exams are not intended to be a complete health exam
or replace William’s visits to their health care provider.
Some of the NHANES exams and tests are usually done with people who have specific health problems.
William’s results may show something abnormal but do not represent an illness. If you take William’s
results to William’s health care provider, they may recommend other tests that may or may not identify
a health concern. You will be responsible for any costs associated with these additional tests.
You are responsible for securing William’s test results. If you do not want anyone else to see their
results, keep them secure so no one else can review them. As promised in our confidentiality
agreement, we do not report these results to health care providers or to public health departments.
If you have any questions regarding William’s results, please feel free to contact me toll-free between 9
am and 5 pm Eastern Time, Monday through Friday, at 1-800-452-6115 (press 1 for English and press
2 for Spanish).
Sincerely,

11f-29

Preliminary Report of Findings
Date of Examination: January 25, 2025
Participant Name: William Cooper
Participant Age at Exam: 8 years

Participant Gender: Male
SP ID: 12345

Body Measurements
William’s body measurements were
Weight

110 lbs 9 oz

Height

4 feet 10 inches

Body Mass Index

23 kg/m2

Waist Circumference 32.6 inches

For additional information about child and teen BMI, please see: https://www.cdc.gov/nutrition/.
Blood Pressure & Heart Rate
William’s measurements were

Systolic Blood Pressure: 1114 mm/hg
Diastolic Blood Pressure: 62 mm/hg
Resting Pulse Rate: 88 Beats/ min

* Based on the Clinical Practice Guidelines for Screening and Management of High Blood Pressure in
Children and Adolescents Subcommittee on screening and Management of High Blood Pressure in
children. Pediatrics. 2017;140(3) e201071904

For additional information about visual acuity, please see: https://www.cdc.gov/visionhealth/.

11f-30

Preliminary Report of Findings
Oral Health Exam
During the NHANES health exam, an oral health assessment was completed by a dental hygienist. The oral
health assessment of NHANES is not intended to be a substitute for the exam provided by your dentist or
oral health provider. The sNHANES oral health assessment did not include a comprehensive dental history or
x-rays.
The dental examiner recommends that William:

See a dentist within the next 2 weeks.

The dental examiner observed the following
conditions:

Decayed teeth/dental restoration issue.
Clinical impression of soft tissue condition.

For more information about maintaining your oral health see https://www.cdc.gov/oralhealth/ basics/
index.html.
Audiometry Acuity
Right Ear

The test indicates normal low frequencies hearing and a mild high frequency hearing loss.

Left Ear

The test indicates normal low frequencies hearing and a mild high frequency hearing loss.

500

1,000

2,000

3,000

4,000

6,000

8,000

Right Ear

Left Ear

This kind of hearing loss could cause your child to miss some speech sounds to have difficulty hearing speech.
The audiometry test can identify a hearing problem but cannot determine the cause of hearing loss.
It is recommended that William sees a health care provider regarding their hearing loss if they have not already
done so.

For additional information on maintaining hearing, please see https://www.cdc.gov/hearingloss/
default.html.
Complete Blood Count
Test
Red Blood Count (RBC)

Result

Units

3.7

x10 /L

Flag

Reference Range
3.5-5.34

Hematocrit

Low

32-45.9

Hemoglobin

g/dL

Low

10.6-15.6

Mean Corpuscular Volume (MCV)

88.2

74.6-98.2

Mean Corpuscular Hemoglobin (MCH)

27.0

24.3-33.8

MCH Concentration (MCHC)

33.1

g/dL

32.1-35.3

Red Cell Distribution Width (RDW)

15.1

11.4-16.3
3

11f-31

Preliminary Report of Findings
Complete Blood Count
Test

Result

Units

Flag

White Blood Count (WBC)

9.2

x10 /L

4-11.6

Absolute Lymphocytes

4.2

x10 /L

0.6-6.1

9
9

Reference Range

Absolute Monocytes

7.2

x10 /L

3.8-11.6

Absolute Neutrophils

1.0

x109/L

0.2-1.5

Absolute Eosinophils

0.5

x10 /L

0.0-0.9

Absolute Basophils*

0.1

x10 /L

0.0-0.2

Lymphocytes Percentage

15.1

14.1-47.6

9
9

Monocytes Percentage

4.2

3.8-11.6

Neutrophils Percentage

55.1

40.9-78.1

Eosinophils Percentage

6.3

0.6-7.3

Basophils Percentage*

1.7

0.1-2.5

Platelet Count

x10 /L

39.8-78.1

Mean Platelet Volume (MPV)

8.2

6.8-10.2

---Test not done
Please follow up with a health care provider for Complete Blood Count.
*This finding was not confirmed by microscopy and follow-up may be necessary.

11f-32

Preliminary Report of Findings
Laboratory Information
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations include federal standards
applicable to all U.S. facilities or sites that test human specimens for health assessment or to diagnose,
prevent, or treat disease.
The following CLIA-certified laboratories performed the named tests on biologic specimens.
NHANES Mobile Examination Center Laboratory
National Center for Health Statistics
3311 Toledo Road
Hyattsville, MD 20782

Complete blood count

11f-33

11f-B. Early Report of Findings Documentation
A. Adult Hepatitis B Virus/Hepatitis D Virus Letter .............................................................. 11f-35
B. Minor Hepatitis B Virus/Hepatitis D Virus Letter ............................................................. 11f-44
C. Adult Hepatitis C Virus Letter ........................................................................................... 11f-53
D. Minor Hepatitis C Virus Letter .......................................................................................... 11f-55
E. Adult Mercury Letter .......................................................................................................... 11f-57
F. Minor Mercury Letter ......................................................................................................... 11f-59
G. Adult Hemoglobin Variants Letter .................................................................................... 11f-61
H. Minor Hemoglobin Variants Letter.................................................................................... 11f-63
I. Adult Butyrylcholinesterase Letter ...................................................................................... 11f-65
J. Minor Butyrylcholinesterase Letter..................................................................................... 11f-67
K. Adult High Urine Arsenic Letter ....................................................................................... 11f-69
L. Minor High Urine Arsenic Letter ....................................................................................... 11f-73
M. Adult Lung Function Letter ............................................................................................... 11f-77
N. Minor Lung Function Letter .............................................................................................. 11f-79
O. Adult Ophthalmology Letter .............................................................................................. 11f-81
P. General/Any Lab Adult ...................................................................................................... 11f-83
N. General/Any Lab Minor ..................................................................................................... 11f-85

Early Reporting Letter – Hepatitis B Adult Page 1 of 2
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Dear {SP FIRST NAME},
Recently, you took part in the National Health and Nutrition Examination Survey (NHANES). The
survey is run by the National Center for Health Statistics, part of the Centers for Disease Control and
Prevention (CDC). As part of this exam, your blood was tested for the hepatitis B virus. Your blood
sample taken on {SP Exam Date}, shows you have a current or previous infection with the hepatitis
B virus, even though you may never have felt sick. Having received the vaccine for hepatitis B would
NOT cause this test to be positive. You may or may not still have the virus in your blood.
Some people with hepatitis B may also have hepatitis D, but this is uncommon in the United States.
Because you are hepatitis B–positive, your blood was also tested for the hepatitis D virus. We will not
know the results of the hepatitis D test for 3 to 4 months. If the hepatitis D test is positive, you will
receive a notification informing you of the positive hepatitis D result.
If no one has told you before that you had the virus, we strongly recommend you take this letter to
your health care provider as soon as you can. Your provider may want to do more tests to find out
whether the virus has done any damage to your liver and may want to prescribe treatment for hepatitis
B. It is also important to discuss how to prevent spreading the disease to other people. You may
obtain other information on hepatitis B by contacting these resources:
CDC: https://www.cdc.gov/hepatitis/hbv/index.htm
American Liver Foundation: 1-800-465-4837, https://liverfoundation.org/
We urge you to follow up with your own health care provider regarding these results. The NHANES
program will not pay for any follow-up tests or care you may need, but we will be available to talk with
you or your provider about your results and answer any questions.
You are responsible for securing your test results. If you do not want anyone else to review your
results, place them in a secure place where no one else can review them. As promised in our
confidentiality agreement, we do not report these results to health care providers or to public health
departments.

11f-35

Early Reporting Letter – Hepatitis B Adult Page 2 of 2
You can reach me toll-free from 9 am to 5 pm Eastern Time at 1-800-452-6115 (press 1 for English
and press 2 for Spanish).
Sincerely,

The following CLIA-certified laboratory performed the hepatitis B virus test:
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road NE, Mailstop US12-3
Atlanta, GA 30329-4018

All Hepatitis B Early Reports are accompanied by one of the included flyers:
Hepatitis B General Information is available in English or Spanish and was most recently updated by
CDC in 2016.
Living with Hepatitis B is available in multiple languages and was most recently updated by CDC in
2015.

11f-36

HEPATITIS B
General Information
What is hepatitis?

How is Hepatitis B spread?

“Hepatitis” means inflammation of the liver. The liver
is a vital organ that processes nutrients, filters the
blood, and fights infections. When the liver is
inflamed or damaged, its function can be affected.
Heavy alcohol use, toxins, some medications, and
certain medical conditions can cause hepatitis.
However, hepatitis is most often caused by a virus. In
the United States, the most common types of viral
hepatitis are Hepatitis A, Hepatitis B, and Hepatitis C.

The Hepatitis B virus is spread when blood, semen, or
other body fluids from an infected person enters the
body of someone who is not infected. The virus can
be spread through:

The only way to know if
you have Hepatitis B is to
get tested.

What is Hepatitis B?
Hepatitis B can be a serious liver disease that results
from infection with the Hepatitis B virus. Acute
Hepatitis B refers to a short-term infection that
occurs within the first 6 months after someone is
infected with the virus. The infection can range in
severity from a mild illness with few or no symptoms
to a serious condition requiring hospitalization. Some
people, especially adults, are able to clear, or get rid
of, the virus without treatment. People who clear the
virus become immune and cannot get infected with
the Hepatitis B virus again.
Chronic Hepatitis B refers to a lifelong infection with
the Hepatitis B virus. The likelihood that a person
develops a chronic infection depends on the age at
which someone becomes infected. Up to 90% of infants
infected with the Hepatitis B virus will develop a chronic
infection. In contrast, about 5% of adults will develop
chronic Hepatitis B. Over time, chronic Hepatitis B can
cause serious health problems, including liver
damage, cirrhosis, liver cancer, and even death.

• Sex with an infected person. Among adults,
Hepatitis B is often spread through sexual contact.
• Injection drug use. Sharing needles, syringes, and
any other equipment to inject drugs with someone
infected with Hepatitis B can spread the virus.
• Outbreaks. While uncommon, poor infection
control has resulted in outbreaks of Hepatitis B in
healthcare settings.
• Birth. Hepatitis B can be passed from an infected
mother to her baby at birth. Worldwide, most
people with Hepatitis B were infected with the virus
as an infant.
Hepatitis B is not spread through breastfeeding,
sharing eating utensils, hugging, kissing, holding
hands, coughing, or sneezing. Unlike some forms of
hepatitis, Hepatitis B is also not spread by
contaminated food or water.

What are the symptoms of
Hepatitis B?
Many people with Hepatitis B do not have symptoms
and do not know they are infected. If symptoms occur,
they can include: fever, feeling tired, not wanting to eat,
upset stomach, throwing up, dark urine, grey-colored
stool, joint pain, and yellow skin and eyes.

When do symptoms occur?
If symptoms occur with an acute infection, they
usually appear within 3 months of exposure and can
last up to 6 months. If symptoms occur with chronic
Hepatitis B, they can take years to develop and can be
a sign of advanced liver disease.
Continued on next page

11f-37

How would you know if you
have Hepatitis B?
The only way to know if you have Hepatitis B is to get
tested. Blood tests can determine if a person has
been infected and cleared the virus, is currently
infected, or has never been infected.

Who should get tested for
Hepatitis B and why?
CDC develops recommendations for testing based
upon a variety of different factors. Here is a list of
people who should get tested. The results will help
determine the next best steps for vaccination or
medical care.
All pregnant women are routinely tested for
Hepatitis B. If a woman has Hepatitis B, timely
vaccination can help prevent the spread of the
virus to her baby.
Household and sexual contacts of people with
Hepatitis B are at risk for getting Hepatitis B.
Those who have never had Hepatitis B can benefit
from vaccination.
People born in certain parts of the world that
have increased rates of Hepatitis B. Testing helps
identify those who are infected so that they can
receive timely medical care.
People with certain medical conditions should
be tested, and get vaccinated if needed. This
includes people with HIV infection, people who
receive chemotherapy and people on
hemodialysis.

How is Hepatitis B treated?
For those with acute Hepatitis B, doctors usually
recommend rest, adequate nutrition, fluids, and
close medical monitoring. Some people may need
to be hospitalized. People living with chronic
Hepatitis B should be evaluated for liver problems
and monitored on a regular basis. Treatments are
available that can slow down or prevent the effects
of liver disease.

Can Hepatitis B be prevented?
Yes. The best way to prevent Hepatitis B is by getting
vaccinated. The Hepatitis B vaccine is typically given
as a series of 3 shots over a period of 6 months. The
entire series is needed for long-term protection.

Who should get vaccinated
against Hepatitis B?
All infants are routinely vaccinated for Hepatitis B
at birth, which has led to dramatic declines of new
Hepatitis B cases in the US and many parts of the
world. The vaccine is also recommended for people
living with someone infected with Hepatitis B,
travelers to certain countries, and healthcare and
public safety workers exposed to blood. People with
high-risk sexual behaviors, men who have sex with
men, people who inject drugs, and people who have
certain medical conditions, including diabetes,
should talk to their doctor about getting vaccinated.

For more information
Talk to your doctor, call your health department, or
visit www.cdc.gov/hepatitis.

People who inject drugs are at increased risk for
Hepatitis B but testing can tell if someone is
infected or could benefit from vaccination to
prevent getting infected with the virus.
Men who have sex with men have higher rates
of Hepatitis B. Testing can identify unknown
infections or let a person know that they can
benefit from vaccination.

June 2016

www.cdc.gov/hepatitis
11f-38

HEPATITIS B
Living with Hepatitis B
What is Hepatitis B?

How is Hepatitis B treated?

Hepatitis B is a liver disease. It is caused by the Hepatitis B virus.
For some people who get Hepatitis B, the virus stays in the body,
causing a lifelong illness. Hepatitis B can cause serious health
problems over time. These problems can include liver cancer and
liver failure.

It is important to be checked regularly by a doctor experienced
in treating Hepatitis B. Many people with Hepatitis B see their
doctor one to two times a year for an exam, blood tests, and liver
tests. The doctor will use these tests to help decide what medical
care is needed. Medications, called antivirals, can be used to treat
many people with Hepatitis B. However, these medications may
not help everyone. Some people live with Hepatitis B for many
years before needing to take medications. Talk to your doctor
about the best treatment for you and if medication would help.
Your doctor will look at the condition of your liver and other
health problems you might have.

How is Hepatitis B spread?
Hepatitis B is spread when someone comes in contact with blood
from a person who has the disease. Most people born in Asia who
have Hepatitis B were infected as infants or young children.
Hepatitis B can be passed from an infected mother to her baby at
birth or from a family member to young children.

How do I take care of my liver?

Hepatitis B is not a genetic disease. People also do not get
Hepatitis B from sharing meals, bowls or utensils with someone
who has the disease. Hepatitis B is not spread through
breastfeeding, hugging, kissing, holding hands, coughing,
or sneezing.

If you have Hepatitis B,
see a doctor regularly to
take care of your health.
What are the symptoms of Hepatitis B?
Most people who have Hepatitis B do not know they have it. The
disease does not always cause symptoms. Hepatitis B can stay
hidden in the body. Many people can live with Hepatitis B for
many years without feeling sick. Still, liver damage from the
disease can take place during this time.

How serious is Hepatitis B?
Hepatitis B can become very serious. For some people, this
disease leads to liver damage, like liver failure or cancer.

Check with your doctor before taking any prescription,
over-the-counter medications, supplements or vitamins.
Some drugs, such as certain pain medications, can
potentially damage the liver.

Avoid alcohol since it can increase the speed of liver damage.

Ask your doctor if you should get the Hepatitis A vaccine.

How do I protect my family members from
getting Hepatitis B?
People who find out they have Hepatitis B can also keep other
family members healthy. Doctors will want to test all family members
of people with Hepatitis B. The test involves a simple blood test
that takes only a small amount of blood from a person’s arm.

Why should my family get tested for Hepatitis B?
Family members who have Hepatitis B should see a doctor. Other
family members who do not have the disease should get the
Hepatitis B vaccine. The vaccine is safe and protects people who
have never had Hepatitis B from getting infected. This helps
prevent liver disease and liver cancer that can come from getting
Hepatitis B.

cdc.gov/knowhepatitisB
July 2015

11f-39

Letter – Hepatitis D Adult Page 1 of 2
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}
{DATE}
Dear {SP FIRST NAME},
Recently, you took part in the National Health and Nutrition Examination Survey (NHANES). The
survey is run by the National Center for Health Statistics, part of the Centers for Disease Control and
Prevention (CDC). As part of this exam, your blood was tested for the hepatitis D virus and hepatitis B
virus.
We notified you of your positive hepatitis B virus test on {HBV Letter date} and informed you that
your blood was also tested for hepatitis D virus because of your positive hepatitis B test. Your blood
sample, taken on {MEC EXAM DATE}, shows you are infected with the hepatitis D virus along with the
hepatitis B virus, even though you may have never felt sick.
Hepatitis D only happens in people who also have the hepatitis B virus. You can have hepatitis D for a
short time, or it can become a long-term, chronic infection. Hepatitis D can cause serious illness that
can lead to lifelong liver damage in some people.
We strongly recommend you see your health care provider soon to discuss treatment and how to
prevent spreading the disease to other people. The NHANES program will not pay for any follow-up
tests or care you may require, but we will be available to talk with you or your provider about this letter
and to answer any questions.
You are responsible for securing your test results. If you do not want anyone else to review your
results, place them in a secure location so no one else can review them. As promised in our
confidentiality agreement, we do not report these results to health care providers or to public health
departments.

11f-40

Letter – Hepatitis D Adult Page 2 of 2
You can reach me on our toll-free number from 9 am to 5 pm Eastern Time at 1-800-452-6115 (press 1
for English and press 2 for Spanish).
Sincerely,

Duong Nguyen, D.O.
Captain, U.S. Public Health Service
Chief Medical Officer, Division of Health and Nutrition Examination Surveys
National Center for Health Statistics, Centers for Disease Control and Prevention
Enclosure
{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed the hepatitis D virus test:
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road NE, Mailstop US12-3
Atlanta, GA 30329-4018
All Hepatitis D Early Reports are accompanied by this flyer developed by CDC:
Hepatitis D
Questions and Answers for the Public.
It was last updated on May 1, 2022.

11f-41

Viral Hepatitis

Hepatitis D Questions and Answers for the Public
• What is hepatitis D?
• What is hepatitis B/hepatitis D coinfection?
• What is hepatitis D superinfection?
• How common is hepatitis D in the United States?
• Where is hepatitis D most common?
• How is hepatitis D spread?
• Besides contact with blood and body ﬂuids from an infected person, are there other ways I could get hepatitis D?
• Who is at risk for hepatitis D?
• Am I at risk for hepatitis D if I was vaccinated against hepatitis B?
• Who is more likely to have long-term health problems, like progressive liver damage, following hepatitis D virus infection?
• What are the signs and symptoms of hepatitis D?
• Are the symptoms of coinfection diﬀerent than symptoms of superinfection?
• How do I ﬁnd out if I’m infected with the hepatitis D virus?
• How is hepatitis D treated?
• How can I prevent hepatitis D?
What is hepatitis D?
Hepatitis D is a liver infection caused by the hepatitis D virus. Only people infected with the hepatitis B virus can get hepatitis D. They
can become infected with both viruses at the same time (known as “coinfection”) or get hepatitis D after ﬁrst being infected with
hepatitis B virus (known as “superinfection”). Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver
damage and even death.
What is hepatitis B/hepatitis D coinfection?
People who get infected with both hepatitis B and hepatitis D at the same time are considered to be coinfected. Coinfection with
hepatitis B and hepatitis D can cause serious, short-term health problems and even liver failure, but it usually does not lead to lifelong illness.
What is hepatitis D superinfection?
Superinfection happens when people get hepatitis D after having been ﬁrst infected with the hepatitis B virus. This type of infection is
more likely to result in long-term illness, including rapid development of liver ﬁbrosis, liver failure, and even death.
How common is hepatitis D in the United States?
Hepatitis D is considered to be uncommon in the United States. However, the number of people with hepatitis D is unknown, because
this infection is not tracked by public health departments or by CDC.
Where is hepatitis D most common?
Hepatitis D is most common in Eastern Europe, Southern Europe, the Mediterranean region, the Middle East, West and Central Africa,
East Asia, and the Amazon Basin in South America.
How is hepatitis D spread?
You can only get hepatitis D after coming into contact with the blood or body ﬂuids of someone who is infected with the hepatitis D
virus. This can happen through
• having sex with an infected person
• sharing needles, syringes, or any other equipment used to prepare or inject drugs
• birth to an infected mother (although this is rare)
• contact with blood from the open sores of an infected person
• needle sticks or exposures to sharp instruments
• sharing personal items (e.g., razors and toothbrushes) that11f-42
may have come in contact with an infected persons blood.

Besides contact with blood and body ﬂuids from an infected person, are there other ways I could get hepatitis D?
No. The hepatitis D virus is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding,
coughing, or sneezing.
Who is at risk for hepatitis D?
People at risk for hepatitis D are also at risk for hepatitis B. You may be at increased risk if you are
• infected with the hepatitis B virus
• an injection-drug user
• a sex partner of someone infected with the hepatitis B virus and/or hepatitis D virus
• coinfected with HIV and the hepatitis B virus
• a man who has sex with men
Am I at risk for hepatitis D if I was vaccinated against hepatitis B?
No. People who get the hepatitis B vaccine are also protected against hepatitis D.
Who is more likely to have long-term health problems, like progressive liver damage, following hepatitis D virus infection?
People who get hepatitis D after being infected with the hepatitis B virus (“superinfection”) are much more likely to experience liver
damage, and even death, from their infection than those who get both infections at the same time (“coinfection”).
What are the signs and symptoms of hepatitis D?
People with hepatitis D can have more severe symptoms than those who are infected with hepatitis B alone. The signs and symptoms
of hepatitis D usually appear 3–7 weeks after infection with the hepatitis D virus. They include:
• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored stool
• Joint pain
• Jaundice
Are the symptoms of coinfection diﬀerent than symptoms of superinfection?
Yes. People who get infected with both viruses at the same time (“coinfection”) can have distinct sets of symptoms during two
separate time periods. This happens because symptoms of hepatitis B may occur at a diﬀerent time than those of hepatitis D. People
who get hepatitis D after ﬁrst being infected with the hepatitis B virus (“superinfection”) usually experience rapid and severe
symptoms. This type of infection can lead to serious long-term health outcomes, like liver disease and death.
How do I ﬁnd out if I’m infected with the hepatitis D virus?
If you are experiencing symptoms of hepatitis D, visit your health-care provider. A blood test is needed to detect infection with the
virus that causes hepatitis D.
How is hepatitis D treated?
A prescription medication called interferon can help some patients, and new treatments are being studied. People with end-stage liver
disease as a result of hepatitis D may need a liver transplant.
How can I prevent hepatitis D?
To prevent hepatitis D, you can get vaccinated against hepatitis B. Although no vaccine is available for hepatitis D, getting the hepatitis
B vaccine also protects you from hepatitis D.
Page last reviewed: May 1, 2020
Content source: Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention

11f-43

Early Reporting Letter – Hepatitis B Child Page 1 of 2
Parent/Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

To the Parent/Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP FIRST NAME} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers for
Disease Control and Prevention (CDC). As part of this exam, {SP FIRST NAME}’s blood was tested for
the hepatitis B virus. {SP FIRST NAME}’s blood sample taken on {MEC EXAM DATE} shows that {SP
FIRST NAME} has a current or previous infection with the hepatitis B virus, even though they may have
never felt sick. Having received the vaccine for hepatitis B would NOT cause this test to be positive.
{SP FIRST NAME} may or may not still have the virus in their blood.
Some people with hepatitis B may also have hepatitis D, but this is uncommon in the United States.
Because {SP FIRST NAME} is hepatitis B–positive, their blood will also be tested for the hepatitis D
virus. We will not know the results of the hepatitis D test for 3 to 4 months. If {SP FIRST NAME}’s
hepatitis D test is positive, we will inform you.
If no one has told {SP FIRST NAME} before that they had the virus, we strongly recommend this
letter be taken to their health care provider as soon as possible. {SP FIRST NAME}’s provider may
want to do more tests to find out whether the virus has done any damage to {SP FIRST NAME}’s
liver and discuss possible treatment for hepatitis B. It will be also important for {SP FIRST NAME} to
understand how to prevent spreading the disease to other people. More information on hepatitis B is
available from these resources:
CDC: https://www.cdc.gov/hepatitis/hbv/index.htm
American Liver Foundation: 1-800-465-4837, https://liverfoundation.org/
We urge you to follow up with {SP FIRST NAME}’s health care provider regarding these results. The
NHANES program will not pay for any follow-up tests or care that may be needed, but we will be
available to talk with you, {SP FIRST NAME}, or their provider about these results and answer any
questions.
You are responsible for securing {SP FIRST NAME}’s results. If you do not want anyone else to review
{SP FIRST NAME}’s results, place them in a secure place where no one else can review them. As
promised in our confidentiality agreement, we do not report these results to health care providers or to
public health departments.

11f-44

Early Reporting Letter – Hepatitis B Child Page 2 of 2
You can reach me toll-free from 9 am to 5 pm Eastern Time at 1-800-452-6115 (press 1 for English
and press 2 for Spanish).
Sincerely,

Duong Nguyen, D.O.
Captain, U.S. Public Health Service
Chief Medical Officer, Division of Health and Nutrition Examination Surveys
National Center for Health Statistics, Centers for Disease Control and Prevention
Enclosure
{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed the hepatitis B virus test:
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road NE, Mailstop US12-3
Atlanta, GA 30329-4018

11f-45

HEPATITIS B
General Information
What is hepatitis?

How is Hepatitis B spread?

The Hepatitis B virus is spread when blood, semen, or
other body fluids from an infected person enters the
body of someone who is not infected. The virus can
be spread through:

The only way to know if
you have Hepatitis B is to
get tested.

11f-46

For more information
Talk to your doctor, call your health department, or
visit www.cdc.gov/hepatitis.

June 2016

www.cdc.gov/hepatitis
11f-47

HEPATITIS B
Living with Hepatitis B
What is Hepatitis B?

How is Hepatitis B treated?

How do I take care of my liver?

How serious is Hepatitis B?
Hepatitis B can become very serious. For some people, this
disease leads to liver damage, like liver failure or cancer.

Check with your doctor before taking any prescription,
over-the-counter medications, supplements or vitamins.
Some drugs, such as certain pain medications, can
potentially damage the liver.

Avoid alcohol since it can increase the speed of liver damage.

Ask your doctor if you should get the Hepatitis A vaccine.

cdc.gov/knowhepatitisB
July 2015

11f-48

National Health and Nutrition Examination Survey

Letter – Hepatitis D Child Page 1 of 2
Parent or Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}
To the Parent or Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP FIRST NAME} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers for
Disease Control and Prevention. As part of this exam, {SP FIRST NAME}’s blood was tested for the
hepatitis D virus and hepatitis B virus.
We notified you of {SP FIRST NAME}’s positive hepatitis B virus test on {HBV Letter Date}. The letter
explained that {SP FIRST NAME}’s blood was also tested for the hepatitis D virus because they are
hepatitis B–positive. {SP FIRST NAME}’s blood sample taken on {MEC EXAM DATE} shows {SP FIRST
NAME} is infected with the hepatitis D virus along with the hepatitis B virus, even though {SP FIRST
NAME} may have never felt sick.
Hepatitis D only happens in people who also have the hepatitis B virus. You can have hepatitis D for a
short time, or it can become a long-term, chronic infection. Hepatitis D can cause serious illness that
can lead to lifelong liver damage in some people.
We strongly recommend {SP FIRST NAME} be seen by their own provider for further testing, to
discuss treatment and how to prevent spreading the disease to other people. The NHANES program
will not pay for any follow-up tests or care {SP FIRST NAME} may require, but we will be available to
talk with you and {SP FIRST NAME} or their provider to answer any questions.
You are responsible for securing {SP FIRST NAME}’s test results. If you do not want anyone else to
review {SP FIRST NAME}’s results, place them in a secure place where no one else can review them.
As promised in our confidentiality agreement, we do not report these results to health care providers
or to public health departments.

11f-49

National Health and Nutrition Examination Survey

Letter – Hepatitis D Child Page 2 of 2
You or {SP FIRST NAME} can reach me toll-free from 9 am to 5 pm Eastern Time at
1-800-452-6115 (press 1 for English and press 2 for Spanish).
Sincerely,

All Hepatitis D Early Reports are accompanied by this flyer developed by CDC:
Hepatitis D
Questions and Answers for the Public.
It was last updated on May 1, 2022.

11f-50

Viral Hepatitis

Hepatitis D Questions and Answers for the Public
• What is hepatitis D?
• What is hepatitis B/hepatitis D coinfection?
• What is hepatitis D superinfection?
• How common is hepatitis D in the United States?
• Where is hepatitis D most common?
• How is hepatitis D spread?
• Besides contact with blood and body ﬂuids from an infected person, are there other ways I could get hepatitis D?
• Who is at risk for hepatitis D?
• Am I at risk for hepatitis D if I was vaccinated against hepatitis B?
• Who is more likely to have long-term health problems, like progressive liver damage, following hepatitis D virus infection?
• What are the signs and symptoms of hepatitis D?
• Are the symptoms of coinfection diﬀerent than symptoms of superinfection?
• How do I ﬁnd out if I’m infected with the hepatitis D virus?
• How is hepatitis D treated?
• How can I prevent hepatitis D?
What is hepatitis D?
Hepatitis D is a liver infection caused by the hepatitis D virus. Only people infected with the hepatitis B virus can get hepatitis D. They
can become infected with both viruses at the same time (known as “coinfection”) or get hepatitis D after ﬁrst being infected with
hepatitis B virus (known as “superinfection”). Hepatitis D can cause severe symptoms and serious illness that can lead to life-long liver
damage and even death.
What is hepatitis B/hepatitis D coinfection?
People who get infected with both hepatitis B and hepatitis D at the same time are considered to be coinfected. Coinfection with
hepatitis B and hepatitis D can cause serious, short-term health problems and even liver failure, but it usually does not lead to lifelong illness.
What is hepatitis D superinfection?
Superinfection happens when people get hepatitis D after having been ﬁrst infected with the hepatitis B virus. This type of infection is
more likely to result in long-term illness, including rapid development of liver ﬁbrosis, liver failure, and even death.
How common is hepatitis D in the United States?
Hepatitis D is considered to be uncommon in the United States. However, the number of people with hepatitis D is unknown, because
this infection is not tracked by public health departments or by CDC.
Where is hepatitis D most common?
Hepatitis D is most common in Eastern Europe, Southern Europe, the Mediterranean region, the Middle East, West and Central Africa,
East Asia, and the Amazon Basin in South America.
How is hepatitis D spread?
You can only get hepatitis D after coming into contact with the blood or body ﬂuids of someone who is infected with the hepatitis D
virus. This can happen through
• having sex with an infected person
• sharing needles, syringes, or any other equipment used to prepare or inject drugs
• birth to an infected mother (although this is rare)
• contact with blood from the open sores of an infected person
• needle sticks or exposures to sharp instruments
• sharing personal items (e.g., razors and toothbrushes) that11f-51
may have come in contact with an infected persons blood.

11f-52

Early Reporting Letter Hepatitis C - Adult
{{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Dear {SP FIRST NAME},
Recently, you took part in the National Health and Nutrition Examination Survey (NHANES).
The survey is run by the National Center for Health Statistics, part of the Centers for Disease
Control and Prevention (CDC). As part of this exam, we tested your blood for the hepatitis C
virus. Your blood sample collected on {MEC EXAM DATE}, shows you are currently infected
with the hepatitis C virus even though you may never have felt sick. If no one has told you
before that you have the virus, we strongly recommend that you take this letter to your
health care provider as soon possible. Your provider may want to do more tests to find out
whether the virus has damaged your liver and talk with you about treatment for hepatitis C. It
is also important for you to learn about how to prevent spreading the disease to other people.
Tell your health care provider that our laboratory is determining the genotype of the hepatitis
virus; however, the result will not be available for several months. You can call us at the phone
number provided below to get the result. This information may be useful in deciding which
hepatitis C treatment is best for you.
More than two million Americans are infected with the hepatitis C virus. Most people who
are infected carry the virus for the rest of their lives. Even though many people with the virus
never feel sick, hepatitis C can lead to liver damage. We have enclosed a fact sheet with
information on hepatitis C. More information on hepatitis C is available from these resources:
CDC: https://www.cdc.gov/hepatitis
American Liver Foundation: 1-800-465- 4837, https://liverfoundation.org/

11f-53

You are responsible for securing your test results. If you do not want anyone else to see your
results, place them in a secure location where no one else can find them. As promised in our
confidentiality agreement, we will not report your results to health care providers or to public
health departments.
If you have any questions, you can reach me toll-free at 1-800-452-6115 (press 1 for English
and press 2 for Spanish) between 9 a.m. and 5 p.m. Eastern Time, Monday through Friday.
Sincerely,

{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed the hepatitis C virus test:
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
1600 Clifton Road NE, Mailstop US12-3
Atlanta, GA 30329-4018

All Hepatitis C Early Reports are accompanied by one of the included flyers.
Hepatitis C – General Information is available in English or Spanish and was most recently
updated by CDC in 2020.

11f-54

Early Reporting Letter – Hepatitis C Child
To Parent/Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

To the Parent/Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP FIRST NAME} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers
for Disease Control and Prevention (CDC). As part of this exam {SP FIRST NAME}’s blood was
tested for the hepatitis C virus. {SP FIRST NAME}’s blood sample, taken on {MEC EXAM DATE},
shows {SP FIRST NAME} is currently infected with the hepatitis C virus, even though they may
never have felt sick. If no one has told you or {SP FIRST NAME} before that they have the virus,
we strongly recommend taking this letter to their health care provider as soon possible. {SP
FIRST NAME}’s provider may want to do more tests to find out whether the virus has damaged
{SP FIRST NAME}’s liver and discuss treatment for hepatitis C. It is also important for {SP FIRST
NAME} to learn about how to prevent spreading the disease to other people.
{SP FIRST NAME}’s health care provider should know that our laboratory is determining the
genotype of the hepatitis virus; however, the result will not be available for several months.
You can call us at the phone number provided below to get the result. This information may
be useful in deciding which hepatitis C treatment is best for {SP FIRST NAME}.
More than 2.2 million Americans are infected with hepatitis C virus. Most persons who are
infected carry the virus for the rest of their lives. Even though many people with the virus
never feel sick, hepatitis C can lead to liver damage. We have enclosed a fact sheet on
hepatitis C and you can find more information on the virus from these resources:
CDC: https://www.cdc.gov/hepatitis/hcv/index.htm
American Liver Foundation: 1-800-465- 4837, https://liverfoundation.org/

11f-55

We urge you to help {SP FIRST NAME} follow up with their health care provider about these
results. The NHANES program will not pay for any follow-up tests or care that may be
needed, but we will be available to talk with you, {SP FIRST NAME}, or their provider about
these results and answer any questions.
You are responsible for securing {SP FIRST NAME}’s test results. If you do not want anyone
else to review {SP FIRST NAME}’s results, place them in a secure place where no one else
can review them. As promised in our confidentiality agreement, we do not report these results
to health care providers or to public health departments.
You can reach me toll-free from 9 a.m. to 5 p.m. at 1-800-452-6115 (press 1 for English and
press 2 for Spanish).
Sincerely,

All Hepatitis C Early Reports are accompanied by one of the included flyers.
Hepatitis C – General Information is available in English or Spanish and was most recently
updated by CDC in 2020.

11f-56

Mercury Adult Page 1 of 2
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Total Blood Mercury

Your value

Elevated level*

xx.x 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.

Mercury is a metal found in our environment. The test results in the table show that you have been
exposed to mercury at higher levels than would be expected. The most common cause of high
mercury levels in the blood is eating a large amount of fish from waters that have high levels of
mercury. Depending on your environment, there may be other reasons that your blood mercury level is
high.
We strongly recommend you take this letter to your health care provider to discuss these results.
Exposure to mercury at high levels can affect your health. The NHANES program will not pay for any
follow-up tests or care you may require, but we will be available to talk with you or your providers
about this letter and to answer any questions. I can be reached toll-free at 1-800-452-6115 (press 1 for
English and press 2 for Spanish) between 9 am and 5 pm Eastern Time, Monday through Friday.

11f-57

Mercury Adult Page 2 of 2
You are responsible for securing the test results. If you do not want anyone else to review your results,
place them in a secure place so no one else can review them. As promised in our confidentiality
agreement, we do not report these results to health care providers or to public health departments.
Sincerely,

{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed the mercury level test:
Centers for Disease Control and Prevention
Division of Laboratory Sciences
Inorganic and Radiation Analytical Toxicology (IRAT)
4770 Buford Hwy NE
Atlanta, GA 30341

11f-58

Mercury Child Page 1 of 2
Parent or Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Total Blood Mercury

Your value

Elevated level*

xx.x ug/L

>= 5.8 ug/L

Mercury is a metal found in our environment. The test results in the table show that {SP FIRST NAME}
has been exposed to mercury at higher levels than would be expected. The most common cause of
high mercury levels in the blood is eating a large amount of fish from waters that have high levels of
mercury. Depending on your environment, there may be other reasons that {SP FIRST NAME}’s blood
mercury level is high.
We strongly recommend you take this letter to {SP FIRST NAME}’s health care provider to discuss
these results. Exposure to mercury at high levels can affect {SP FIRST NAME}’s health. The NHANES
program will not pay for any follow-up tests or care {SP FIRST NAME} may require, but we will
be available to talk with you or {SP FIRST NAME}’s providers about this letter and to answer any
questions. I can be reached toll-free at 1-800-452-6115 (press 1 for English and press 2 for Spanish)
between 9 am and 5 pm Eastern Time, Monday through Friday.

11f-59

Mercury Child Page 2 of 2
You are responsible for securing the test results. If you do not want anyone else to review {SP FIRST
NAME}’s results, place them in a secure place so no one else can review them. As promised in our
confidentiality agreement, we do not report these results to health care providers or to public health
departments.
Sincerely,

11f-60

{SP FIRST NAME}{SP LAST NAME}
{STREET MAILING ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}
Dear {SP FIRST NAME},
Recently, you 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. We reviewed your test results from the examination on {MEC EXAM DATE}
and found that some results were abnormal and require your immediate attention.
Hemoglobin variant trait is an inherited condition that affects the hemoglobin in your red blood
cells. Hemoglobin is a protein in red blood cells. The job of hemoglobin is to carry oxygen
through the body.
As part of your examination, we tested your blood for certain hemoglobin variants, which are
caused by genetic abnormalities that affect red blood cells. Your blood sample, collected on
{MEC EXAM DATE}, was found to have {XX}% Hemoglobin {S/ C/ D/ E/ F}. If you were not
already aware of this, we highly recommend that you follow up with your own health
care provider. These results could impact some aspects of your future medical care and
family planning.
Hemoglobin variants are usually found in people whose families originated from areas
including Africa, the Middle East, or Asia. In the United States, these variants are usually
discovered during newborn screening programs. However, some people, including those born
outside of the United States, may not be aware they have this condition.
People who have hemoglobin variants may experience a range of symptoms. The severity of
symptoms depends on the type and percentage of variant in an individual’s blood. We have
provided you with the percentage of the variant in your blood. You should give this information
to your health care provider when you follow up with them.

11f-61

Page 2 –
The NHANES program will not pay for any follow-up tests or care you may require, but we
will be available to talk with you or your health care provider about this result and answer any
questions you may have. You are responsible for securing your test results. If you do not want
anyone else to review your results place them in a secure place so no one else can review
them. As promised with our confidentiality agreement to you, we do not report your results
to health care providers or to public health departments. You can reach me at our toll-free
number at 1-800-452-6115 (press 1 for English and press 2 for Spanish), Monday through
Friday from 9:00 am to 5:00 pm.

Sincerely,

11f-62

Parent or Guardian of {SP FIRST NAME} {SP LAST NAME}
{STREET MAILING ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}
Dear Parent or Guardian of {SP FIRST NAME},
Recently, {SP FIRST NAME} 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. We reviewed your child’s test results from the
examination on {MEC EXAM DATE} and found that some results were abnormal and require
your immediate attention.
Hemoglobin variant trait is an inherited condition that affects the hemoglobin in your red blood
cells. Hemoglobin is a protein in red blood cells. The job of hemoglobin is to carry oxygen
through the body.
As part of their examination, we tested {SP FIRST NAME}’s blood for certain hemoglobin
variants, which are caused by genetic abnormalities that affect red blood cells. {SP FIRST
NAME}’s blood sample, collected on {MEC EXAM DATE}, was found to have {XX}%
Hemoglobin {S/ C/ D/ E/ F}. If you or {SP FIRST NAME} were not already aware of this, we
highly recommend that you follow up with {SP FIRST NAME}’s own health care provider.
These results could impact some aspects of {SP FIRST NAME}’s future medical care and
family planning.
Hemoglobin variants are usually found in people whose families originated from areas
including Africa, the Middle East, or Asia. In the United States, these variants are usually
discovered during newborn screening programs. However, some people, including those born
outside of the United States, may not be aware they have this condition.

11f-63

Page 2 –
People who have hemoglobin variants may experience a range of symptoms. The severity of
symptoms depends on the type and percentage of variant in an individual’s blood. We have
provided you with the percentage of the variant in {SP FIRST NAME}’s blood. You should give
this information to {SP FIRST NAME}’s health care provider when you follow up with them.
The NHANES program will not pay for any follow-up tests or care {SP FIRST NAME} may
require, but we will be available to talk with you or {SP FIRST NAME}’s health care provider
about this result and answer any questions you may have. You are responsible for securing
{SP FIRST NAME}’s test results. If you do not want anyone else to review {SP FIRST NAME}’s
results, place them in a secure place so no one else can review them. As promised with
our confidentiality agreement to you, we do not report {SP FIRST NAME}’s results to health
care providers or to public health departments. You can reach me at our toll-free number at
1-800-452-6115 (press 1 for English and press 2 for Spanish), Monday through Friday from
9 am to 5 pm Eastern Time.

Sincerely,

11f-64

Adults Butyrylcholinesterase
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Dear {SP FIRST NAME},
Recently, you took part in the National Health and Nutrition Examination Survey. The survey is run by
the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. We
reviewed your test results from your exam on {MEC Exam Date}. We found that some results need
your attention.
Your value
Total Blood Butyrylcholinesterase
{xx.x} U/ml
* 0.05 U/ml is the lowest reportable level of this test.

*Reference Range
≥ 0.05 U/ml

It is important for you to know that your butyrylcholinesterase level is low as it may be important to
your health. The low butyrylcholinesterase level might mean that your body takes longer to break
down certain medicines used to relax muscles during general anesthesia for surgery, and you can
have complications such as breathing difficulties after surgery. Certain people are born with this
condition while others develop it from medications, exposure to pesticides, liver disease, pregnancy,
and others. Please consult with your healthcare provider about your low butyrylcholinesterase level.
Although the risk of complications is rare, it is important to tell them that you were found to have a low
butyrylcholinesterase level.
The NHANES test for butyrylcholinesterase levels is a newly developed test designed to test the level
of butyrylcholinesterase in the general population. This is different from the test used in clinics or
hospitals that may be more specific to your health care needs. Your health care provider may want to
repeat this test to confirm this level.
You are responsible for securing your test results. If you do not want anyone else to review
your results, place them in a secure place so no one else can review them. As promised in our
confidentiality agreement, we do not report these results to health care providers or to public health
departments.

These measurements were obtained as part of a survey and do not represent a
medical diagnosis.
Interpretation of these measurements must be made by an appropriately licensed
health care provider.
{SP FIRST NAME} {SP LAST NAME}, {SP DOB}, Date of Exam: {MEC EXAM DATE}

11f-65

The NHANES program will not pay for any follow-up tests or care you may require. However, we will
be available to talk with you or your health care providers about this letter, your butyrylcholinesterase
level, and to answer any questions. If you have any questions, you can reach me toll-free at 1-800452-6115 (press 1 for English and press 2 for Spanish) between 9 am and 5 pm Eastern Time, Monday
through Friday.
Sincerely,

11f-66

CHILD Butyrylcholinesterase
Parent or Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}
{DATE}
Dear Parent or Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP First Name} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers for
Disease Control and Prevention. We reviewed {SP First Name}’s test results from the exam on {MEC
Exam Date}. We found that some results need your attention.
Your value
Total Blood Butyrylcholinesterase
{xx.x} U/ml
* 0.05 U/ml is the lowest reportable level of this test.

*Reference Range
≥ 0.05 U/ml

It is important for you to know that your butyrylcholinesterase level is low as it may be important to
your health. The low butyrylcholinesterase level might mean that your body takes longer to break
down certain medicines used to relax muscles during general anesthesia for surgery, and you can
have complications such as breathing difficulties after surgery. Certain people are born with this
condition while others develop it from medications, exposure to pesticides, liver disease, pregnancy,
and others. Please consult with your healthcare provider about your low butyrylcholinesterase level.
Although the risk of complications is rare, it is important to tell them that you were found to have a low
butyrylcholinesterase level.
The NHANES test for butyrylcholinesterase levels is a newly developed test designed to test the level
of butyrylcholinesterase in the general population. This is different from the test used in clinics or
hospitals that may be more specific to {SP First Name}’s health care needs. Their health care provider
may want to repeat this test to confirm the level.
You are responsible for securing {SP First Name}’s test results. If you do not want anyone else to
review {SP First Name}’s results, place them in a secure place so no one else can review them. As
promised in our confidentiality agreement, we do not report these results to health care providers or to
public health departments.

These measurements were obtained as part of a survey and do not represent a
medical diagnosis.
Interpretation of these measurements must be made by an appropriately licensed
health care provider.
{SP FIRST NAME} {SP LAST NAME}, {SP DOB}, Date of Exam: {MEC EXAM DATE}

11f-67

The NHANES program will not pay for any follow-up tests or care {SP First Name} may require.
However, we will be available to talk with you or {SP First Name}’s health care providers about this
letter and to answer any questions. If you have any questions, you can reach me toll-free at 1-800452-6115 (press 1 for English and press 2 for Spanish) between 9 am and 5 pm Eastern Time, Monday
through Friday.
Sincerely,

11f-68

Adult Urine Arsenic 1 of 4
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}
{DATE}
Dear {SP FIRST NAME},
Recently, you took part in the National Health and Nutrition Examination Survey (NHANES). The
survey is run by the National Center for Health Statistics, part of the Centers for Disease Control
and Prevention. As part of this exam, your urine was tested for arsenic, a metal widespread in the
environment. The arsenic level in your urine sample taken on {MEC Exam Date} was above the usual
range of 50 ug/L.
This suggests that you were exposed to arsenic during the week before the exam. We strongly
recommend that you take this letter to your health care provider as soon as you can to discuss if you
may need additional testing or any treatment. For additional information about arsenic please see
https://www.atsdr.cdc.gov/toxfaqs/tfacts2.pdf.
The NHANES program will not pay for any follow-up tests or care you may require, but we will be
available to talk with you or your providers about this letter and to answer any questions. If you have
any questions, you can reach me toll-free at 1-800-452-6115 (press 1 for English and press 2 for
Spanish) between 9 am and 5 pm Eastern Time, Monday through Friday.
You are responsible for securing your test results. If you do not want anyone else to review
your results, place them in a secure place so no one else can review them. As promised in our
confidentiality agreement, we do not report these results to health care providers or to public health
departments.
Sincerely,

11f-69

Adult Urine Arsenic 2 of 4
The following CLIA-certified laboratory performed the urine level test:
Centers for Disease Control and Prevention
Division of Laboratory Sciences
Inorganic and Radiation Analytical Toxicology (IRAT)
4770 Buford Hwy NE
Atlanta, GA 30341

11f-70

Adult Urine Arsenic 3 of 4
{DATE}
Regarding
Participant Name: {SP FIRST NAME} {SP LAST NAME}
Participant DOB: {MM/DD/YYYY}
Participant Gender: {Male/Female}
{SP FIRST NAME} {SP LAST NAME} has voluntarily 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. The objective of the survey is to obtain information on the
health and nutrition status of the U.S. population. The survey was performed on a random sample of
individuals living in your region.
{SP FIRST NAME}’s results showed a urine arsenic level that was above the expected range,
warranting this report.
Test
Total urinary arsenic

Participant’s value
{XXX} ug/L

Reference range
See below

Total urinary arsenic values greater than 50 ug/L are suggestive of increased exposure to arsenic
during the week before the urine collection date. The incidence of health effects is indeterminate in the
range of 50–200 ug/L. On a long-term basis, the incidence of health effects is low for people who have
a urinary arsenic concentration greater than 200 ug/L. However, these health effects increase with time
and concentration level of exposure. The effects of chronic arsenic include skin pigmentation changes,
plantar and palmar hyperkeratotic papules, peripheral vascular insufficiency, and increased incidence
of skin, bladder, and lung cancers.
Urinary arsenic concentration levels will represent a person’s most recent exposures (within days or
weeks). The levels do not indicate length of exposure. Concentration may increase or decrease at
different times depending on changes in exposure (intake), personal activities, diet, timing of specimen
collection, and the influence of health conditions. People with the same intake may have differences in
levels because of the influence of these factors and genetic differences.
Reference comparison values for normal populations will vary with the population and the conditions
under which the study was performed. Reference comparison values may vary with age, gender, race,
location, activities, analytic methods, and other factors. Urine arsenic levels in healthy adults between
5 and 50 µg/L generally correspond to whole blood arsenic levels between 2–23 µg/L. (Ref: Tietz, R.E.
Ed.: Clinical Guide to Laboratory Tests. 3rd ed. Philadelphia, W.B. Saunders Col, 1995.)

11f-71

Adult Urine Arsenic 4 of 4
The NHANES examination was not intended to be a complete physical examination or a substitute
for routine or ongoing health care. NHANES is not authorized to administer treatment or engage in
any follow-up care with the survey participants. However, we are available to answer any questions
regarding this report, the examination, the results, or NHANES in general. Please feel free to contact
me at the National Center for Health Statistics between 9 am and 5 pm Eastern Time, Monday through
Friday, at 1-800-452-6115 (press 1 for English and press 2 for Spanish).
Sincerely,

Duong Nguyen, D.O.
Captain, U.S. Public Health Service
Chief Medical Officer, Division of Health and Nutrition Examination Surveys
National Center for Health Statistics, Centers for Disease Control and Prevention
Enclosure
{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed the urine level test:
Centers for Disease Control and Prevention
Division of Laboratory Sciences
Inorganic and Radiation Analytical Toxicology (IRAT)
4770 Buford Hwy NE
Atlanta, GA 30341

11f-72

Child Urine Arsenic page 1 of 4
Parent or Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}
{DATE}
Dear Parent or Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP FIRST NAME} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers for
Disease Control and Prevention. As part of this exam, {SP FIRST NAME}’s urine was tested for arsenic,
a metal widespread in the environment. The arsenic level in {SP FIRST NAME}’s urine sample taken on
{MEC Exam Date} was above the expected range of 50 ug/L.
This suggests that {SP FIRST NAME} was exposed to arsenic during the week before their exam.
We strongly recommend you take this letter to {SP FIRST NAME}’s health care provider as soon as
you can to discuss if {SP FIRST NAME} may need additional testing or any treatment. For additional
information regarding arsenic please see https://wwwn.cdc.gov/TSP/ToxFAQs/ToxFAQsDetails.
aspx?faqid=19&toxid=3.
The NHANES program will not pay for any follow-up tests or care {SP FIRST NAME} may require, but
we will be available to talk with you or {SP FIRST NAME}’s providers about this letter and to answer
any questions. If you have any questions, you can reach me toll-free at 1-800-452-6115 (press 1 for
English and press 2 for Spanish) between 9 am and 5 pm Eastern Time, Monday through Friday.
You are responsible for securing {SP FIRST NAME}’s test results. If you do not want anyone else to
review {SP FIRST NAME}’s results, place them in a secure place so no one else can review them. As
promised in our confidentiality agreement, we do not report these results to health care providers or to
public health departments.

11f-73

Child Urine Arsenic page 2 of 4
Sincerely,

Enclosure
{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed the urine level test:
Centers for Disease Control and Prevention
Division of Laboratory Sciences
Inorganic and Radiation Analytical Toxicology (IRAT)
4770 Buford Hwy NE
Atlanta, GA 30341

11f-74

Child Urine Arsenic page 3 of 4
{DATE}
Regarding
Participant Name: {SP FIRST NAME} {SP LAST NAME}
Participant DOB: {MM/DD/YYYY}
Participant Gender: {Male/Female}
{SP FIRST NAME} {SP LAST NAME} has voluntarily 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. The objective of the survey is to obtain information on the
health and nutrition status of the U.S. population. The survey was performed on a random sample of
individuals living in your region.
{SP FIRST NAME}’s results showed a urine arsenic level that was above the expected range,
warranting this report.
Test
Total urinary arsenic

Participant’s value
{XXX} ug/L

Reference range
< 50 ug/L

11f-75

Child Urine Arsenic page 4 of 4
The NHANES examination was not intended to be a complete physical examination or a substitute
for routine or ongoing health care. NHANES is not authorized to administer treatment or engage in
any follow-up care with the survey participants. However, we are available to answer any questions
regarding this report, these results, or NHANES in general. Please feel free to contact me toll-free
at 1-800-452-6115 (press 1 for English and press 2 for Spanish) between 9 am and 5 pm, Monday
through Friday, Eastern Time.
Sincerely,

11f-76

{DATE}

{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{SP CITY, STATE, ZIP MAILING ADDRESS}
Dear {SP FIRST NAME}:
Recently, you took part in the National Health and Nutrition Examination Survey (NHANES). The survey
is run by the National Center for Health Statistics, part of the Centers for Disease Control and
Prevention. This test was done to know how well your lungs work by measuring how much air you
breathed in, how much air you breathed out, and how quickly you breathed it out. Trained professionals
evaluated your lung function test but did not have information about your lung health or general health
status. Lung function testing was done using the Easy on-PC spirometer. Compared with other people
of your age, sex, and height, your breathing test results were outside normal limits. Your results are
consistent with {possible restriction or non-specific pattern; OR airflow obstruction; OR possible mixed
pattern}.
Lung Function Testing*
Measure

Best

LLN

z-score

% Pred

FVC (L)

{FVCBES}xx.xx

{FVCLLN}xx.xx

{FVCZ}x.xx

{FVCPRE}xxx

FEV1 (L)

{FEVBES} xx.xx

{FEVLLN}xx.xx

{FEVZ} x.xx

{FEVPRE}xxx

FEV1/FVC

{VCBEST} xx.xx

{VCDLLN}xx.xx

{VCBZ} x.xx

{VCBPRE} xxx

FET (s)

{FETBEST} xx.x

FVC – forced vital capacity; FEV1 – forced expiratory volume in 1 second; FET – forced expiratory time; LLN –
lower limit of normal; z-score – statistic describing how far the best value deviates from the predicted value; %
Pred – percent of the predicted value.
Reference values used to calculate LLN, z-score, and % Predicted are based on the Global Lung Function
Initiative (GLI) Global reference equations.
* Based on Bowerman C, Bhakta NR, Brazzale D, et al. A Race-neutral Approach to the Interpretation of
Lung Function Measurements. Am J Respir Crit Care Med. 2023;207(6):768-774

For more information on maintaining healthy lungs see https://www.cdc.gov/asthma/ communityhealth/.

11f-77

Page 2 –

We strongly recommend you take this letter to your health care provider to discuss these
results and determine whether you may need additional testing. The NHANES program will not
pay for any follow-up tests or care you may require, but we will be available to talk with you or
your providers about this letter and to answer any questions. You can reach me toll-free at 1800-452-6115 (press 1 for English and press 2 for Spanish) between 9 am and 5 pm, Eastern
Time, Monday through Friday.
You are responsible for securing your test results. If you do not want anyone else to see your
results, keep them secure so no one else can review them. As promised in our confidentiality
agreement, we do not report these results to health care providers or to public health
departments.
Sincerely,

Duong Nguyen, D.O.
Captain, U.S. Public Health Service
Chief Medical Officer, Division of Health and Nutrition Examination Surveys
National Center for Health Statistics
Centers for Disease Control and Prevention
{SP ID}
{OMB NUMBER}
{OMB EXP DATE}

11f-78

{DATE}

Parent or Guardian of
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}
Dear Parent or Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP FIRST NAME} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers for
Disease Control and Prevention. As part of this exam, testing was done to know how well {SP FIRST
NAME}‘s lungs work by measuring how much air they breathed in, how much air they breathed out, and
how quickly they breathed it out. Trained professionals evaluated the lung function test but did not have
information about {SP FIRST NAME}‘s lung health or general health status. Lung function testing was
done using the Easy on-PC spirometer. Compared with other people of {SP FIRST NAME}’s age, sex,
and height, their breathing test results were outside normal limits. {SP FIRST NAME}‘s results are
consistent with { possible restriction or non-specific pattern; OR airflow obstruction; OR possible mixed
pattern}.
Lung Function Testing*
Measure

Best

LLN

z-score

% Pred

FVC (L)

{FVCBES}xx.xx

{FVCLLN}xx.xx

{FVCZ}x.xx

{FVCPRE}xxx

FEV1 (L)

{FEVBES} xx.xx

{FEVLLN}xx.xx

{FEVZ} x.xx

{FEVPRE}xxx

FEV1/FVC

{VCBEST} xx.xx

{VCDLLN}xx.xx

{VCBZ} x.xx

{VCBPRE} xxx

FET (s)

{FETBEST} xx.x

FVC – forced vital capacity; FEV1 – forced expiratory volume in 1 second; FET – forced expiratory time; LLN –
lower limit of normal; z-score – statistic describing how far the best value deviates from the predicted value; %
Pred – percent of the predicted value.
Reference values used to calculate LLN, z-score, and % Predicted are based on the Global Lung Function
Initiative (GLI) Global reference equations.
* Based on Bowerman C, Bhakta NR, Brazzale D, et al. A Race-neutral Approach to the Interpretation of
Lung Function Measurements. Am J Respir Crit Care Med. 2023;207(6):768-774

For more information on maintaining healthy lungs see https://www.cdc.gov/asthma/ communityhealth/.

11f-79

Page 2 –

We strongly recommend you take this letter to {SP FIRST NAME}’s health care provider to
discuss these results and determine whether they may need additional testing. The NHANES
program will not pay for any follow-up tests or care {SP FIRST NAME} may require, but we will
be available to talk with you or {SP FIRST NAME}’s provider about this letter and to answer any
questions. You can reach me toll-free at 1-800-452-6115 (press 1 for English and press 2 for
Spanish) between 9 am and 5 pm, Eastern Time, Monday through Friday.
You are responsible for securing {SP FIRST NAME}’s test results. If you do not want anyone
else to see their results, keep them secure so no one else can review them. As promised in our
confidentiality agreement, we do not report these results to health care providers or to public
health departments.
Sincerely,

11f-80

{DATE}

{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{SP CITY, STATE, ZIP MAILING ADDRESS}
Dear {SP FIRST NAME}:
Recently, you took part in the National Health and Nutrition Examination Survey (NHANES). The survey
is run by the National Center for Health Statistics, part of the Centers for Disease Control and
Prevention. Digital images of the back of your eye, the retina, were taken during your NHANES
examination. Trained professionals evaluated the images and found the following condition(s)*
Eye condition(s) requiring an appointment with an eye doctor (ophthalmologist)
IMMEDIATELY:
{Specific Retinal Pathology} {Written Interpretation}
{Specific Retinal Pathology} {Written Interpretation}
Eye condition(s) requiring an appointment with an eye doctor (ophthalmologist) within the
next MONTH:
{Specific Retinal Pathology} {Written Interpretation}
{Specific Retinal Pathology} {Written Interpretation}
Eye condition(s) requiring an appointment with an eye doctor (ophthalmologist) within the
next TWO MONTHS:
{Specific Retinal Pathology} {Written Interpretation}
{Specific Retinal Pathology} {Written Interpretation}

We strongly recommend you take this letter to your eye doctor (ophthalmologist) to discuss these
results and determine whether you may need additional testing. The NHANES program will not pay for
any follow-up tests or care you may require, but we will be available to talk with you or your providers
about this letter and to answer any questions. You can reach me toll-free at 1-800-452-6115 (press 1
for English and press 2 for Spanish) between 9 am and 5 pm, Eastern Time, Monday through Friday.

11f-81

Page 2 –

You are responsible for securing your test results. If you do not want anyone else to see your
results, keep them secure so no one else can review them. As promised in our confidentiality
agreement, we do not report these results to health care providers or to public health
departments.
Sincerely,

11f-82

Any Lab Adult Page 1 of 2
{SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Result

Units

Flag

{Lab-specific tests}
Note: Rows repeat to include
all tests in a panel/profile
---Test not done
Please follow up with a health care provider regarding the {GEN LAB}
{For more information about {GEN LAB INFO}}

11f-83

Reference Range

Note

Any Lab Adult Page 2 of 2
We strongly recommend you take this letter to your health care provider to discuss these results
and determine whether you may need additional testing. The NHANES program will not pay for any
follow-up tests or care you may require, but we will be available to talk with you or your providers
about this letter and to answer any questions. I can be reached toll-free at 1-800-452-6115 (press 1
for English and press 2 for Spanish) between 9 am and 5 pm Eastern Time, Monday through Friday.
You are responsible for securing your test results. If you do not want anyone else to see your results,
keep them secure so no one else can review them. As promised in our confidentiality agreement, we
do not report these results to health care providers or to public health departments.
Sincerely,

{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed {ROF LAB} level:
[Place holder here Laboratory Name and Address]

11f-84

Any Lab Child Page 1 of 2
Parent or Guardian of {SP FIRST NAME} {SP LAST NAME}
{SP ADDRESS}
{CITY, STATE ZIP MAILING ADDRESS}

{DATE}

Dear Parent or Guardian of {SP FIRST NAME} {SP LAST NAME},
Recently, {SP FIRST NAME} took part in the National Health and Nutrition Examination Survey
(NHANES). The survey is run by the National Center for Health Statistics, part of the Centers for
Disease Control and Prevention. As part of this exam, {SP FIRST NAME}’s samples were tested, and it
was found that their {ROF LAB} level was outside normal limits.
{GEN LAB}
• Diabetes Test
• Thyroid Function Tests
• Kidney Function Tests
• Liver Function Tests
• Lipid Profile and Cholesterol
• Reproductive Hormones
• Iron Profile
• Nutritional Biochemistries
• General Chemistry
• Environmental Health Profile Blood Test for Cadmium, Lead, Manganese, Selenium
• Environmental Health Profile Urine Test for Chromium, Nickel
Test

Result

Units

Flag

11f-85

Reference Range

Note

Any Lab Child Page 2 of 2
We strongly recommend you take this letter to {SP FIRST NAME}’s health care provider to discuss
these results and determine whether {SP FIRST NAME} needs additional testing or treatment. The
NHANES program will not pay for any follow-up tests or care {SP FIRST NAME} may require, but we
will be available to talk with you or {SP FIRST NAME}’s providers about this letter and to answer any
questions. I can be reached toll-free at {SUPPORT PHONE} (press 1 for English and press 2 for Spanish) between 9 am and 5 pm Eastern Time, Monday through Friday.
You are responsible for securing {SP FIRST NAME}’s test results. If you do not want anyone else to
see their results, keep them secure so no one else can review them. As promised in our confidentiality
agreement, we do not report these results to health care providers or to public health departments.
Sincerely,

{SP ID}
{OMB NUMBER}
{OMB EXP DATE}
The following CLIA-certified laboratory performed {ROF LAB}:
[Place holder here Laboratory Name and Address]

11f-86

File Type	application/pdf
File Title	Microsoft Word - Attachment_Template.docx
Author	mmyers
File Modified	2024-06-20
File Created	2024-06-20