ARIC Data Book. Cohort, Exam 1. Medication Survey Form: FORM CODE=MSR VERSION=A
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1 Page 1 of 17 Medication Survey Form: FORM CODE=MSR VERSION=A Instructions: This form should be completed in three stages. Section A should be completed at the Reception station. The transcription portion of Section B should be completed while the participant proceeds with the visit. The interview portion of Section B, as well as Sections C & D, should then be completed during the physical exam. Whenever numerical responses are required, enter the number so that the last digit appears in the rightmost box. Enter leading zeroes where necessary to fill all boxes. ID Aric Subject ID (Cir) Present Text suppressed A. RECEPTION MSRA01 Bring all meds used in past 2 weeks? Q N No 761 S Some of them [skip to Q.3] Y Yes, all [skip to B. MEDICATION RECORDS] 10 Missing MSRA02 Reason why did not bring all meds Q2 590 F Forgot or was unable to bring medications 2395 T Took no medications [skip to Q.9] Missing MSRA03 Get medication information later? Q N No or not applicable 277 Y Yes Missing B. MEDICATION RECORDS MSRA04AA Medication Name & Concentration Q4aa Present Text suppressed 2496 Missing
2 Page 2 of 17 MSRA04AB Medication Code No. Q4ab 3308 Present Text suppressed Missing MSRA04AC Medication A Prescription Type Q4ac 4461 O OTC 8456 R RX 342 S Shared 10 U Unknown 2522 Missing MSRA04AD Take Medication A In Past 24 Hrs? Q4ad 6497 N No 34 U Unknown 6731 Y Yes 2529 Missing MSRA04BA Medication Name & Concentration Q4ba Present Text suppressed 4869 Missing MSRA04BB Medication Code No. Q4bb 2695 Present Text suppressed Missing
3 Page 3 of 17 MSRA04BC Medication B Prescription Type Q4bc 4562 O OTC 6050 R RX 284 S Shared 6 U Unknown 4889 Missing MSRA04BD Take Medication B In Past 24 Hrs? Q4bd 5618 N No 19 U Unknown 5260 Y Yes 4894 Missing MSRA04CA Medication Name & Concentration Q4ca 8332 Present Text suppressed 7459 Missing MSRA04CB Medication Code No. Q4cb 1997 Present Text suppressed Missing MSRA04CC Medication C Prescription Type Q4cc 4095 O OTC 3949 R RX 260 S Shared 9 U Unknown 7478 Missing
4 Page 4 of 17 MSRA04CD Take Medication C In Past 24 Hrs? Q4cd 4500 N No 19 U Unknown 3786 Y Yes 1 ` 7485 Missing MSRA04DA Medication Name & Concentration Q4da 6145 Present Text suppressed 9646 Missing MSRA04DB Medication Code No. Q4db 1398 Present Text suppressed Missing MSRA04DC Medication D Prescription Type Q4dc 1 N 3429 O OTC 2486 R RX 214 S Shared 5 U Unknown 9656 Missing MSRA04DD Take Medication D In Past 24 Hrs? Q4dd 3450 N No 14 U Unknown 2665 Y Yes 9662 Missing
5 Page 5 of 17 MSRA04EA Medication Name & Concentration Q4ea 4378 Present Text suppressed Missing MSRA04EB Medication Code No. Q4eb 979 Present Text suppressed Missing MSRA04EC Medication E Prescription Type Q4ec 2610 O OTC 1603 R RX 148 S Shared 6 U Unknown Missing MSRA04ED Take Medication E In Past 24 Hrs? Q4ed 2465 N No 10 U Unknown 1887 Y Yes Missing MSRA04FA Medication Name & Concentration Q4fa 3042 Present Text suppressed Missing MSRA04FB Medication Code No. Q4fb 654 Present Text suppressed Missing
6 Page 6 of 17 MSRA04FC Medication F Prescription Type Q4fc O OTC 1004 R RX 99 S Shared 5 U Unknown Missing MSRA04FD Take Medication F In Past 24 Hrs? Q4fd N No 13 U Unknown 1268 Y Yes Missing MSRA04GA Medication Name & Concentration Q4ga 2099 Present Text suppressed Missing MSRA04GB Medication Code No. Q4gb 444 Present Text suppressed Missing MSRA04GC Medication G Prescription Type Q4gc 1383 O OTC 636 R RX 74 S Shared 3 U Unknown Missing
7 Page 7 of 17 MSRA04GD Take Medication G In Past 24 Hrs? Q4gd 1168 N No 5 U Unknown 919 Y Yes Missing MSRA04HA Medication Name & Concentration Q4ha 1437 Present Text suppressed Missing MSRA04HB Medication Code No. Q4hb 306 Present Text suppressed Missing MSRA04HC Medication H Prescription Type Q4hc 972 O OTC 412 R RX 51 S Shared 1 U Unknown Missing MSRA04HD Take Medication H In Past 24 Hrs? Q4hd 814 N No 3 U Unknown 616 Y Yes Missing MSRA04IA Medication Name & Concentration Q4ia 958 Present Text suppressed Missing
8 Page 8 of 17 MSRA04IB Medication Code No. Q4ib 184 Present Text suppressed Missing MSRA04IC Medication I Prescription Type Q4ic 655 O OTC 257 R RX 38 S Shared 5 U Unknown Missing MSRA04ID Take Medication I In Past 24 Hrs? Q4id 547 N No 2 U Unknown 405 Y Yes Missing MSRA04JA Medication Name & Concentration Q4ja 643 Present Text suppressed Missing MSRA04JB Medication Code No. Q4jb 118 Present Text suppressed Missing MSRA04JC Medication J Prescription Type Q4jc 453 O OTC 162 R RX 25 S Shared Missing
9 Page 9 of 17 MSRA04JD Take Medication J In Past 24 Hrs? Q4jd 365 N No 275 Y Yes Missing MSRA04KA Medication Name & Concentration Q4ka 448 Present Text suppressed Missing MSRA04KB Medication Code No. Q4kb 76 Present Text suppressed Missing MSRA04KC Medication K Prescription Type Q4kc 321 O OTC 105 R RX 19 S Shared 1 U Unknown Missing MSRA04KD Take Medication K In Past 24 Hrs? Q4kd 250 N No 206 Y Yes Missing MSRA04LA Medication Name & Concentration Q4la 281 Present Text suppressed Missing
10 Page 10 of 17 MSRA04LB Medication Code No. Q4lb 61 Present Text suppressed Missing MSRA04LC Medication L Prescription Type Q4lc 195 O OTC 71 R RX 15 S Shared 4 U Unknown Missing MSRA04LD Take Medication L In Past 24 Hrs? Q4ld 169 N No 4 U Unknown 112 Y Yes Missing MSRA04MA Medication Name & Concentration Q4ma 199 Present Text suppressed Missing MSRA04MB Medication Code No. Q4mb 32 Present Text suppressed Missing
11 Page 11 of 17 MSRA04MC Medication M Prescription Type Q4mc 132 O OTC 54 R RX 12 S Shared 1 U Unknown Missing MSRA04MD Take Medication M In Past 24 Hrs? Q4md 110 N No 2 U Unknown 86 Y Yes Missing MSRA04NA Medication Name & Concentration Q4na 135 Present Text suppressed Missing MSRA04NB Medication Code No. Q4nb 16 Present Text suppressed Missing MSRA04NC Medication N Prescription Type Q4nc 89 O OTC 38 R RX 8 S Shared Missing
12 Page 12 of 17 MSRA04ND Take Medication N In Past 24 Hrs? Q4nd 74 N No 61 Y Yes Missing MSRA04OA Medication Name & Concentration Q4oa 89 Present Text suppressed Missing MSRA04OB Medication Code No. Q4ob 8 Present Text suppressed Missing MSRA04OC Medication O Prescription Type Q4oc 58 O OTC 26 R RX 5 S Shared Missing MSRA04OD Take Medication O In Past 24 Hrs? Q4od 54 N No 35 Y Yes Missing MSRA04PA Medication Name & Concentration Q4pa 66 Present Text suppressed Missing
13 Page 13 of 17 MSRA04PB Medication Code No. Q4pb 6 Present Text suppressed Missing MSRA04PC Medication P Prescription Type Q4pc 49 O OTC 13 R RX 4 S Shared Missing MSRA04PD Take Medication P In Past 24 Hrs? Q4pd 33 N No 1 U Yes 32 Y Missing MSRA04QA Medication Name & Concentration Q4qa 51 Present Text suppressed Missing MSRA04QB Medication Code No. Q4qb 5 Present Text suppressed Missing MSRA04QC Medication Q Prescription Type Q4qc 42 O OTC 7 R RX 2 S Shared Missing
14 Page 14 of 17 MSRA04QD Take Medication Q In Past 24 Hrs? Q4qd 38 N No 1 U Unknown 21 Y Yes Missing MSRA05 Total # of medications in bag Q Range 0-33 ( median=3 mean=3.8 std=2.9 ) 2480 Missing MSRA06 # of untranscribable medications Q A Missing MSRA07 Transcriber Code Number Q Present Text suppressed 2491 Missing C. INTERVIEW Were any of the medications you took during the past two weeks for:
15 Page 15 of 17 MSRA08A High Blood Pressure? Q8a 9383 N No 30 U Unknown 4004 Y Yes 2374 Missing MSRA08B Angina or Chest Pain? Q8b N No 24 U Unknown 484 Y Yes 2376 Missing MSRA08C Control of Heart Rhythm? Q8c N No 61 U Unknown 669 Y Yes 2376 Missing MSRA08D Heart Failure? Q8d N No 24 U Unknown 83 Y Yes 2376 Missing MSRA08E Blood Thinning? Q8e N No 46 U Unknown 790 Y Yes 2376 Missing
16 Page 16 of 17 MSRA08F Diabetes or High Blood Sugar? Q8f N No 4 U Unknown 884 Y Yes 2376 Missing MSRA08G Stroke? Q8g N No 9 U Unknown 43 Y Yes 2376 Missing MSRA08H Leg pain when walking? Q8h N No 6 U Unknown 490 Y Yes 2377 Missing MSRA09 During the past two weeks, did you take any Aspirin, Alka-Seltzer, a cold medicine, or a headache powder? Q N No 61 U Unknown 7826 Y Yes 33 Missing MSRA10 During the past two weeks, did you take any (other) medication for arthritis, fever, or muscle aches and pains, (or menstrual cramps)? Q N No 11 U Unknown 1768 Y Yes 36 Missing
17 Page 17 of 17 D. ADMINISTRATIVE INFORMATION MSRA11 Medications Interview Date Q Range 01/16/ /29/ Missing MSRA12 Interviewer Code No. Q Present Text suppressed 16 Missing MSRACY Contact Year MSRAFLAG MSRAFLAG
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