Document 4Jd6n1dYVxGn9NjkXJM17MJ8e

Study ID Number _ _ _ __ Name _ _ __ Please check and update the response to DI 1. Did the primary respondent change during the interview? Interviewer Assessment of Blinding IA 1 Do you believe the patient is case? [J Yes, for certain [J Yes, probable IA 2 If yes, please describe why. [J Do not know IA 3 Do you believe the patient is control? [J Yes, for certain [J Yes, probable IA 4 If yes, please describe why. [J Do not know Time finished: _ _ _ _ _ __ Time spent in interview: (minutes) Version 24 February 2004 CC_DP Questionnaire 15 of 15 SH ELL-MCCLU RG-059293