MALARIA EVOLUTION IN SOUTH ASIA RESEARCH CENTER KGVK ARMD Protocol 01/15/13 v1 Diagnostics Data Report Forms 2
DIAGNOSTICS PAGE 1 INSTRUCTION KEY Follow Patient Sample Protocols for instructions on experiments
Date of Measurement Enter the date that the sample was analyzed as MM/DD/YYYY.
Time of Measurement Enter the time that the sample was analyzed with the 12 hour clock,circling AM or PM. Enter the value to the closest 15 minute period.
Scientist Enter the first and last name of the scientist who did the analysis.
Patient Enter the Patient ID as XX/XX/XXXX.
Processing Protocol Enter the processing protocol with two digits. If uncertain about the protocol used, enter 99.
Initial % Parasitemia Enter the initial % parasitemia as XX.XX%. If the % parasitemia was not measured, enter 88.88. If the % parasitemia is uncertain, enter 99.99.
Parasite Density Enter the parasite density in parasites/L. If the parasite density was not measured, enter 88888888 (eight 8s). If the parasite density was uncertain, enter 99999999 (eight 9s).
Initial Gametocytemia Enter the initial % gametocytemia as XX.XX%. If the % gametocytemia was not measured, enter 88.88. If the % gametocytemia was uncertain, enter 99.99.
Gametocyte Density Enter the gametocyte density in gametocytes/uL. If the gametocyte density was not measured, enter 88888888 (eight 8s). If the gametocyte density was uncertain, enter 99999999 (eight 9s).
MALARIA EVOLUTION IN SOUTH ASIA RESEARCH CENTER KGVK ARMD Protocol 01/15/13 v1 Diagnostics Data Report Forms 3
Diagnostics Page 1
Diagnostics 1. Date of measurement __ __ / __ __ / __ __ __ __ 2. Time of measurement (circle either AM or PM) ___ ___ : ___ ___ AM/PM 3. Scientist _______________________ 4. Patient ID __ __ / __ __ / __ __ __ __ 5. Processing Protocol ____ ____ 6. Initial % Parasitemia __ __ . __ __ % 7. Parasite Density (parasites/L) __ __ __ __ __ __ __ __ 8. Initial % Gametocytemia __ __ . __ __ % 9. Gametocyte Density (gametocytes/L) __ __ __ __ __ __ __ __
MALARIA EVOLUTION IN SOUTH ASIA RESEARCH CENTER KGVK ARMD Protocol 01/15/13 v1 Diagnostics Data Report Forms 4
DIAGNOSTICS PAGE 2 INSTRUCTION KEY Follow Patient Sample Protocols for instructions on experiments
Hemoglobin Enter the hemoglobin value as XX.X g/dL. If the hemoglobin value was not determined, enter 00.0. If the hemoglobin value was uncertain, enter 99.9.
Hematocrit Enter the hematocrit value as XX%. Enter 00 when the hematocrit was not measured. Enter 99 when the hematocrit is uncertain.
Thick blood smear Enter the species infection as determined from the thick blood smear. Write Pf for P. falciparum, Pv for P. vivax, mixed for missed infections and negative for no malaria infection. If the blood smear was not read, write n/a.
Thin blood smear Enter the species infection as determined from the thin blood smear. Write Pf for P. falciparum, Pv for P. vivax, mixed for missed infections and negative for no malaria infection. If the blood smear was not read, write n/a.
RDT Enter the species infection as determined from the RDT. Write Pf for P. falciparum, Pv for P. vivax, mixed for missed infections and negative for no malaria infection. If the RDT was not read, write n/a.
FreezerPro IDs Enter the FreezerPro ID numbers for any aliquots stored after sample processing. This includes RDTs, slide boxes, FTA cards, plasma, white blood cells and all stored pRBCs.
MALARIA EVOLUTION IN SOUTH ASIA RESEARCH CENTER KGVK ARMD Protocol 01/15/13 v1 Diagnostics Data Report Forms 5