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EDIAC Study

What is the EDAIC study?
The EDAIC study is an important research study
that is investigating the risk factors of Chronic Kidney Disease.

How would I know if I am eligible?
We are looking for healthy volunteers age 21 or older. We
will ask you some questions about your health to
see if you qualify.

What is required of me if I qualify?
If you agree to participate and qualify for this study,
we will invite you to 1-2 study visits. During these
visits, we will take your blood pressure, do blood
and urine tests, do an ultrasound test to examine your blood vessel health,
and have you fill out questionnaires regarding your health and lifestyle.

Why should I join the EDAIC study?
If you choose and qualify for this study you will receive:

• FREE cholesterol screening
• FREE diabetes screening
• FREE blood pressure checks
• PLUS the satisfaction of participating in an important project to benefit you, your family, friends and community.

If you qualify for this study and attend the study visits,
you will receive $50.00 per visit to compensate you for your time and effort.

Please fill out this form to see if you qualify for the study.

Name«

Address

City

State

Zip

Home Phone

Work Phone

Cell Phone

Email«

age

Date Of Birth

mm/dd/yy

Sex

male

Female

Race

Best way to contact me

phone

The best time to contact me

If you are eligible, what might be a good time to schedule an appointment with you?

Have you ever been told by a doctor or other health professional that you have Chronic Kidney Disease?

yes

Have you previously received kidney dialysis (peritoneal and/or hemodialysis) lasting more than one month?

yes

Have you ever had a kidney transplant?

yes

Have you ever had cancer?

yes

If yes what kind?

If yes, have you received chemotherapy for this cancer within the past 2 years?

yes

Are you currently participating in any other research study?

yes

In the past 6 mo have you received immunosuppressive drugs such as Cyclophosphamide, Cytoxan, Gengral, Neoral, Sanimmune, Immuran, Prograf, Mycophenotate, Leukeran, steroids, Prednisone, Cellcept, Cyclosporine, Azathioprine, Tacrolimus, or Chlorambucil?

yes

Have you ever been diagnosed with HIV?

yes

Have you received any other organ or bone marrow transplants?

yes

Has a doctor ever told you that you have diabetes?

yes

Have you ever taken medication for diabetes?

yes

Has a doctor ever told you that you have high blood pressure?

yes

Have you ever taken medication for high blood pressure?

yes

If female, are you currently pregnant or breastfeeding?

yes

Fields marked with "«" are required.

Tulane University Office of Health Research
1440 Canal St., Suite 1100, New Orleans, LA 70112
For Information Call | Phone 504.988.4390
CRIC Participants Call: 1-877-414-CRIC

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