These questionnaires/interviews were developed by the Pediatric AIDS Clinical Trials Group sponsored by the NIH/NIAID/NICHD.
The date following the form name is the date the form was last modified (this is the date found in the lower left corner of the form). If the date in the lower left corner of your form copy does not match the date on this web page, please download the latest version of the form. NOTE: The date in the upper right corner of a form is the date the form was added to a CRF notebook.
Learn about the IMPAACT Adherence to Therapy Subcommittee.
To view these files, a PDF reader such as Adobe Reader is required.
Form Number | Form Name | Form Date | English | Spanish | Other Translations |
---|---|---|---|---|---|
NPW0033 | GBS Baseline and Monitoring Tool | 29-MAY-2007 |
npw0033.pdf
|
||
NPW0035 | Guillain-Barre Syndrome (GBS) Baseline and Monitoring Tool - II | 09-SEP-2009 |
npw0035.pdf
|
||
QL0500 | General Health Self-Assessment Form | 06-SEP-1994 |
ql0500.pdf
|
ql0500_spa.pdf
|
|
QL0601 | Overall Health Status Assessment | 05-MAR-1997 |
ql0601.pdf
|
ql0601_spa.pdf
|
|
QL0602 | Multidimensional Health Status Assessment | 05-MAR-1997 |
ql0602.pdf
|
ql0602_spa.pdf
|
|
QL0742 | ACTG Self Report | 22-APR-2002 |
ql0742.pdf
|
ql0742_spa.pdf
|
|
QL4000 | Quality of Life Assessment (For Ages 6 months - 4 Years) | 05-JUL-2001 |
ql4000.pdf
|
ql4000_spa.pdf
|
|
QL4003 | Quality of Life Assessment - Revised (For Ages 6 months - 4 Years) | 15-NOV-2002 |
ql4003.pdf
|
||
QL4004 | Quality of Life Assessment (For Ages 5 - 11 Years) | 15-NOV-2002 |
ql4004.pdf
|
||
QL4005 | Quality of Life Assessment (For Ages 12 - 20 Years) | 14-MAY-2003 |
ql4005.pdf
|
||
QL5001 | Pediatric Adherence Questionnaire Module 2 - General Reasons for Non-Adherence | 05-JUL-2001 |
ql5001.pdf
|
ql5001_spa.pdf
|
|
QL5002 | Pediatric Adherence Questionnaire Module 1 - Revised Behavior/Identification | 05-JUL-2001 |
ql5002.pdf
ql5002scripts.pdf |
ql5002spascripts.pdf
|
|
QL5003 | Pediatric Adherence Questionnaire Module 1 - III - Behavior/Identification | 22-NOV-2004 |
ql5003.pdf
ql5003scripts.pdf |
ql5003spascripts.pdf
|
|
QL5004 | Pediatric Adherence Questionnaire Module 2- Revised - General Reasons for Non-Adherence | 22-NOV-2004 |
ql5004.pdf
|
||
QL5005 | Pediatric Domestic Adherence Questionnaire | 19-SEP-2006 |
ql5005.pdf
|
ql5005_spa.pdf
|
|
QL5010 | Perinatal Adherence Questionnaire Module 2 - General Reasons for Non-Adherence | 05-JUL-2001 |
ql5010.pdf
|
ql5010_spa.pdf
|
|
QL5011 | Perinatal Adherence Questionnaire Module 2 - Revised - General Reasons for Non-Adherence | 22-NOV-2004 |
ql5011.pdf
|
||
QL5020 | Adolescent Adherence Questionnaire Module 2 - General Reasons for Non-Adherence | 05-JUL-2001 |
ql5020.pdf
|
ql5020_spa.pdf
|
|
QL5021 | Adolescent Adherence Questionnaire Module 2 - Revised - General Reasons for Non-Adherence | 21-NOV-2004 |
ql5021.pdf
|
||
QL5022 | Adolescent Adherence Questionnaire | 19-SEP-2006 |
ql5022.pdf
|
ql5022_spa.pdf
|
|
QL5030 | Pediatric International Adherence Questionnaire - Behavior/Identification | 15-OCT-2004 |
ql5030.pdf
ql5030scripts.pdf |
ql5030sesotho.pdf
ql5030zulu.pdf ql5030swahili.pdf |
|
QL6000 | Subject Body Image Questionnaire | 13-MAR-2000 |
ql6000.pdf
|
ql6000_spa.pdf
|
|
QL6001 | Caregiver Body Image Questionnaire | 13-MAR-2000 |
ql6001.pdf
|
ql6001_spa.pdf
|
|
QL7000 | Maternal Baseline Behavioral Self Report | 20-DEC-2002 |
ql7000.pdf
|
ql7000_spa.pdf
|
|
QL7001 | Maternal Behavioral Self Report | 20-DEC-2002 |
ql7001.pdf
|
ql7001_spa.pdf
|
|
QLW0044 | Supplemental Antepartum Adherence Questionnaire | 22-OCT-2001 |
qlw0044.pdf
|
qlw0044_spa.pdf
|
|
QLW0045 | Supplemental Postpartum Adherence Questionnaire | 22-OCT-2001 |
qlw0045.pdf
|
qlw0045_spa.pdf
|