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Visit
Date of the visit:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
*
/
*
/
*
Subject ID
Gender
M
F
Age
Site
Page
Date of data entry
Inclusion
Did you give a blood sample since your last visit?
Yes
No
Specify the date:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Unknown (nk)
*
/
/
*
CRP:
mg/dl
Leucocytes count:
mrd/l
HbA1C:
mg/dl
HDL:
mg/dl
LDL:
mg/dl
Triglyceride:
mg/dl
Blood pressure:
Blood pressure:
/
mmHg
/
/mmHg
Waist circumference:
cm
Height:
cm
Weight:
kg
Body mass index:
Version 4_UKE_Oct2023
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