Get Tlc Trial Form Houses.04 Residence Information Pre ... - Niehs

This guide provides step-by-step instructions for filling out the TLC Trial Form HOUSES.04 Residence Information during your pre-randomization visit. The information collected is essential for the TLC Clinical Center and will be kept confidential.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the TLC Trial Form HOUSES.04.
2. Begin by entering the Center ID, Screening ID, and Visit Code in the specified fields at the top of the form.
3. In the residence information section, provide the name of the child for whom the form is being completed. Ensure this is accurately recorded as it will be referenced throughout the form.
4. Proceed to ask about the different places the child spends time regularly. For each day of the week (Sunday to Saturday), write down the hours spent at each place, such as home, daycare, babysitter, etc. Make sure the total for each day sums to 24 hours and 168 hours for the week.
5. After filling in the hours, calculate the totals for each place. Record these totals in the designated fields provided in the form.
6. Next, identify and fill in the addresses, names, and phone numbers of the four places where the child spends the most time. List them in order of hours spent, providing necessary details for each location.
7. In the section for other children in the household, provide the first and last names, along with the ages and dates of birth for any children under three years old living with the child.
8. Finalize the form by entering the date of the interview and the interviewer's signature. Complete the TLC Code if applicable.
9. Review all entries for accuracy. Once confirmed, you can save changes, download the form for your records, print it, or share it as required.

Complete your documents online for a smooth and efficient process.