Long-term sequela of Rocky Mountain Spotted Fever (RMSF)

OMB 0920-1267

The goal of this study is to describe persistent neurological damage in patients who were hospitalized with RMSF. Resulting data will provide information to healthcare providers, patients, and policy-makers about the long term consequences of severe RMSF, including length of time to recovery, and risk factors during acute illness which may be associated with long-term impairment.

The latest form for Long-term sequela of Rocky Mountain Spotted Fever (RMSF) expires 2022-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Neurologic Exam Form Form
Patient Screening Questionnaire Form
9. IRB Continuation Memo.docx Supplementary Document
8. RMSF-LTS PIA Signed.pdf Supplementary Document
7. Consent documents.pdf Supplementary Document
6. IRB Approval.docx Supplementary Document
5. Chart Abstraction Form.pdf Supplementary Document
2. 60-day FRN.pdf Supplementary Document
1. Section 301 of the Public Health Service Act (42 USC 241).pdf Supplementary Document
Supporting Statement B_LTS_3-18-2019.docx Supporting Statement B
Supporting Statement A_LTS_7-22-2019 CLEAN.docx Supporting Statement A
Neurologic Exam Form Form
Patient Screening Questionnaire Form

All Historical Document Collections

201904-0920-004

Approved with change

New collection (Request for a new OMB Control Number)

2019-05-02

OMB Details

Patient Screening Questionnaire

Federal Enterprise Architecture: Health - Public Health Monitoring

Form none

Patient Screener

Paper Only

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.