1. Annual Status Report

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* NWTSID - ok to leave blank if unknown

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* Email Address

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* Participant's Initials

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* Participant's Date of Birth

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* Zipcode

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* How would you prefer to be contacted in the future regarding Annual Status Reports?

Serious illness or other conditions resulting in hospitalization/surgery or medical treatment since last report?

If yes please use the spaces below to report each event

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* Events to report

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* First Event

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* First Event Date

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* Description/Outcome/Treatment of First Event

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* Second Event

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* Second Event Date

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* Description/Outcome/Treatment of Second Event

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* Third Event

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* Third Event Date

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* Description/Outcome/Treatment of Third Event

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* Additional Comments

Since treatment ended or last report have there been any significant life events such as marriage, pregnancy/parenthood?

If yes please use the spaces below to report each event

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* Events to report

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* First Event

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* First Event Date

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* Description/Outcome of First Event

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* Second Event

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* Second Event Date

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* Description/Outcome of Second Event

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* Third Event

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* Third Event Date

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* Description/Outcome of Third Event

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* Additional Comments

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* Participant offspring to report on?

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