Maritime Health Research and Education-NET/DM2/Diabetes 2 Danish Group/Data Registration Form

Data Registration Form

MAHRE-Net Diabetes Prevalence study start _______finish n = 200 in each country
City :                                       FORM No : ______                                                                             > Protocol
To estimate the real prevalence we invite at random all, regardless of their risk, such as obesity.......................
	Example	1	2	3	4	5	6	7	8	9	10
Date	1/8
Informed Consent (1)	X
Age	22
Gender m/f	m
Nationality (2)	1
Fisherman	X
Seafarer
Years of experience	10
First HbA1c (3)	5.1
Second HbA1c
Height cm	175
Weight kg	75
Comment
(1) Ask the seafarer/fisherman if we can use anonyme data for research (2) Spain = 1, Morocco = 2 , Other = 4 (3) Repeat HbA1c if value ≥ 6.5
Comment participant no.
Comment participant no.

..............................................................................................................................................................................
	Example	11	12	13	14	15	16	17	18	19	20
Date	1/8
Informed Consent (1)	X
Age	22
Gender m/f	m
Nationality (2)	1
Fisherman	X
Seafarer
Years of experience	10
First HbA1c (3)	5.1
Second HbA1c
Height cm	175
Weight kg	75
Comment
(1) Ask the seafarer/fisherman if we can use anonyme data for research (2) Spain = 1, Morocco = 2 , Other = 4 (3) Repeat HbA1c if value ≥ 6.5
Comment participant no.
Comment participant no.