Form 1: ICD Baseline Variables

1. Study ID# and Date

 
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Please enter your Study ID#, instead of your name, to maintain confidentiality. If you do not know your Study ID#, please contact the ARVD office via email, cjames7@jhmi.edu or phone, 443-287-5985.
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1. Study ID# and Date
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2. Please enter the date you are completing this questionnaire:
MM DD YYYY
Date
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