SERIAL NUMBER (8 DIGITS)          CKL        PARTICIPANT NO. 

## National Diet And Nutrition Survey

 

## Nhs Central Register And Cancer Register (Adults 16+)

 The NHS Central Register lists all the people in the country and their National Health Service (NHS) 
number. 
 We would like to ask for your consent for us to send your name, address and date of birth to the National 
Health Service Central Register. A marker will be put against your name to show that you took part in the National Diet and Nutrition Survey. 
 If a person who took part in the National Diet and Nutrition Survey (NDNS) gets cancer, or dies, the type of 
cancer or cause of death will be linked with their answers to the survey. By linking this information the research is more useful as we can look at how people's lifestyle can have an impact on their future health. 
 This information will be confidential and used for research purposes only.  By signing this form you are only giving permission for the linking of this information to routine 
administrative data and nothing else. We will not be able to obtain any other details from your medical records. 
 You can cancel this permission at any time in the future by writing to us at the following address:  
NatCen Social Research, 35 Northampton Square, London EC1V 0AX  
 Your consent I, (name) _____________________________ consent to the NDNS team passing my name, address and date of birth to the **National Health Service Central Register**. I understand that information held by the NHS Central Register may be used to follow up my health status. Signed  
Date I understand that these details will be used for research purposes only. 

 
NDNS(N) 

## National Diet And Nutrition Survey (Ndns) Consent Booklet: Personal Copy

             **Serial Number:**  
 
             **First Name:**  
 

## National Diet And Nutrition Survey (Ndns) Nurse Visit Adult Consent Form (16+ Years)

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

SERIAL NUMBER 
CHECK LETTER 
RESPONDENT No. 


Please initial/tick boxes if consent given 
 
1. 
I confirm that I have read and understand the NDNS Nurse Visit information 
sheet(s) dated 05.02.2014 (version 2) for the above study. I have been given the opportunity to ask questions and have had these answered satisfactorily. 
 
2. 
I understand that my participation is voluntary and that I am free to withdraw from   any part of the study, at any time, without giving a reason and without my medical care or legal rights being affected.  

## Measurements 3. I Agree For My Blood Pressure Results To Be Sent To My Gp.

 

 4. 
I agree for my body mass index (BMI) measurement to be sent to my GP. 

## National Diet And Nutrition Survey (Ndns) Nurse Visit Adult Consent Form (16+ Years)

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

boxes if consent given 
BLOOD SAMPLE 
5. 
I agree to have a blood sample taken as part of the study. 6. 
I give permission that my blood sample taken as part of this study may be stored and, with ethical approval as appropriate, used in future research studies 

 7. 
I would like to receive my blood results which are clinically relevant. 8. 
I consent to my GP being notified of my blood results which are clinically  
 
relevant. 

9. 
You will be required to consent to the statement below if you do not want to receive your blood results AND if you do not want them sent to your GP. receive my blood results which are clinically relevant or have them sent to 

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

SERIAL NUMBER 
CHECK LETTER 
RESPONDENT No. 


Please initial/ tick boxes if consent given 
Name of Child 
 
1. 
I am the parent/guardian of the child named above and I confirm that I have read and understand the NDNS Nurse Visit information sheet(s) dated 05.02.2014 (version 2) for the above study. I have been given the opportunity to ask questions and have had these answered satisfactorily. 2. 
I understand that my child's participation is voluntary and that s/he is free to withdraw from   any part of the study, at any time, without giving a reason and without my medical care or legal rights being affected.  

 MEASUREMENTS 3. 
I agree for my child's blood pressure results to be sent to his/her GP.  
MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

CHECK LETTER 
RESPONDENT No. 
Please initial/tick boxes if consent given BLOOD SAMPLE 4. 
I agree to my child having a blood sample taken as part of the study. 5. 
I give permission that my child's blood sample taken as part of this study may be stored and, with ethical approval as appropriate, used in future research studies 6. 
I would like to receive my child's blood results which are clinically relevant. 7. 
I consent to my child's GP being notified of his/her blood results which are  
 
clinically relevant. 
 
 
8. 
IF you do not want to receive your child's blood results AND if you do not want them sent to their GP, for us to take a blood sample from your child, you will be required to consent to both of the statements below. (i) 
I confirm that against the advice of the NDNS survey team, I do not want 
 
 
to receive my child's blood results which are clinically relevant or have 
 
them  
sent to his/her GP. (ii) 
I agree to the survey doctor contacting me to discuss, if necessary, any 
 
 
results that are directly relevant to my child's health. 

# 

## National Diet And Nutrition Survey (Ndns) Nurse Visit Child Assent Form (5-15 Years)

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

SERIAL NUMBER 
CHECK LETTER 
RESPONDENT No. 
Please circle 
 
Yes / No 
1. 
Has somebody explained what happens at the nurse visit? 
 
Yes / No 2. 
Do you understand what this study is about?  
 
Yes / No 3. 
Have you asked all the questions you want? 
 
Yes / No 4. 
Have you had your questions answered in a way you understand? 
 
Yes / No 5. 
Do you understand it's OK to stop taking part at any time? 
 
Yes / No 6. 
Are you happy to take part? 

 If any answers are 'No' or you don't want to take part, don't sign your name! If you do want to take part, you can write your name below. Your name Date The nurse who explained this study to you needs to sign too: Nurse name Signature 
 
Thank you for helping us! 

 

MREC Reference Number: 13/EE/0016 

boxes if consent given 

## Name Of Child

 
| 1.                                                                              |
|---------------------------------------------------------------------------------|
| and understand the NDNS Nurse Visit information sheet(s) dated 05.02.2014       |
| (version 2) for the above study. I have been given the opportunity to ask ques- |
| tions and have had these answered satisfactorily.                               |
 
2. 
I understand that my child's participation is voluntary and that s/he is free to withdraw from any part of the study, at any time, without giving a reason and without our medical care or legal rights being affected.  

## Blood Sample

3. 
I agree to my child having a blood sample taken as part of the study. 4. 
I give permission that my child's blood sample taken as part of this study may be stored and, with ethical approval as appropriate, used in future research studies. 5. 
I would like to receive my child's blood results which are clinically relevant. 6. 
I consent to my child's GP being notified of his/her blood results which are  
 
clinically relevant. 
7. 

## If You Do Not Want To Receive Your Child'S Blood Results And If You Do Not Want Them Sent To Their Gp, For Us To Take A Blood Sample From Your Child, You Will Be Required To Consent To Both Of The Statements Below. (I) I Confirm That Against The Advice Of The Ndns Survey Team, I Do Not Want

 
 
to receive my child's blood results which are clinically relevant or have 
 
them  
sent to his/her GP. (ii) 
I agree to the survey doctor contacting me to discuss, if necessary, any 
 
 
results that are directly relevant to my child's health. 


## National Diet And Nutrition Survey - Consent Booklet: Office Copy

Please use capital letters and write in ink  

DAY: 
MONTH: 
YEAR: 
2. 
1. 
Nurse number: 


Date schedule completed (all visits complete): 


Full name (of person tested) 
3. 
Name by which GP knows person (if different) 
DAY: 
MONTH: 
YEAR: 
4. 
 
| Sex                                         | Male                                                                       |
|---------------------------------------------|----------------------------------------------------------------------------|
|                                             |                                                                            |
| Female                                      |                                                                            |
| 2                                           |                                                                            |
|                                             |                                                                            |
| Date of birth:                              |                                                                            |
|                                             |                                                                            |
| 6.                                          |                                                                            |
| Full name of parent/guardian                | (if person under 16)                                                       |
| 7.                                          |                                                                            |
|                                             | GP NAME AND ADDRESS                                                        |
| Dr:                                         | ………………………………………………………………….                                                 |
| NURSE USE ONLY                              |                                                                            |
|                                             |                                                                            |
| GP Address complete        1                |                                                                            |
| Practice Name: ……………………………………………………         |                                                                            |
| GP Address not complete        2            |                                                                            |
| Address:                                    | …………………………………………………………..                                                   |
|                                             |                                                                            |
|                                             |                                                                            |
| ………………………………………………………………………                 |                                                                            |
| Town: ……………………………………………………………….             |                                                                            |
| County: ……………………………………………………………..           |                                                                            |
| Postcode: …………………………………………………………..          |                                                                            |
| Telephone no:                               | …………………………………………………….                                                      |
| NO                                          |                                                                            |
| YES                                         |                                                                            |
| 8.                                          |                                                                            |
| SUMMARY OF CONSENTS—RING CODE FOR EACH ITEM |                                                                            |
| a)                                          | Read and understood nurse visit information sheet                          |
| b)                                          | Understand right to withdraw                                               |
| c)                                          | Blood pressure to                                                          |
| d)                                          | Body Mass Index (BMI) to                                                   |
| e)                                          | Sample of blood to be taken                                                |
| f)                                          | Blood sample for storage                                                   |
| g)                                          | Blood sample result to                                                     |
| h)                                          | Blood sample result to                                                     |
| i)                                          | Does not                                                                   |
| 02                                          |                                                                            |
| 04                                          |                                                                            |
| 06                                          |                                                                            |
| 08                                          |                                                                            |
| 10                                          |                                                                            |
| 12                                          |                                                                            |
| 14                                          |                                                                            |
| 16                                          |                                                                            |
| 18                                          |                                                                            |
| 20                                          |                                                                            |
| 01                                          |                                                                            |
| 03                                          |                                                                            |
| 05                                          |                                                                            |
| 07                                          |                                                                            |
| 09                                          |                                                                            |
| 11                                          |                                                                            |
| 13                                          |                                                                            |
| 15                                          |                                                                            |
| 17                                          |                                                                            |
| 19                                          | j)      Agrees survey doctor can contact to discuss results if necessary - |
|                                             | Children aged 1.5-15 years                                                 |

## Blood Sample Laboratory Reference List

The tables below show which blood samples should be taken (in priority order) and need to be sent to each lab for each age group: 

## Participants Aged 16+

Priority 
Blood Tube 
Colour 
Label Reference 
Laboratory 
1 
EDTA 2.6 mL 
Red 
EN1 (3) 
Addenbrookes 
2 
Serum 9.0 mL 
White 
SEN 1 (4) 
Field Lab 
3 
Li Hep TM 7.5 mL 
Orange 
LHN1 (5) 
Field Lab 
4 
Li Hep TM 7.5 mL 
Orange 
LHN2 (6) 
Field Lab 
5 
Fluoride 1.2 mL 
Yellow 
FN1 (7) 
Field Lab 
6 
Li Hep 4.5 mL 
Orange 
LHN3 (8) 
Field Lab 
7 
EDTA 2.6 mL 
Red 
EN2 (9) 
Field Lab PARTICIPANTS AGED 7-15  
Priority 
Blood Tube 
Colour 
Label Reference 
Laboratory 
1 
EDTA 2.6 mL 
Red 
EN1 (3) 
Addenbrookes 
2 
Serum 7.5 mL 
White 
SEN1 (4) 
Field Lab 
3 
Li Hep TM 7.5 mL 
Orange 
LHN1 (5) 
Field Lab 
4 
Li Hep 2.7 mL 
Orange 
LHN2 (6) 
Field Lab 
5 
Fluoride 1.2 mL 
Yellow 
FN1 (7) 
Field Lab PARTICIPANTS AGED 18 mths - 6 yrs  
Priority 
Blood Tube 
Colour 
Label Reference 
Laboratory 
1 
EDTA 2.6 mL 
Red 
EN1 (3) 
Addenbrookes 
2 
Serum 4.5 mL 
White 
SEN1 (4) 
Field Lab 
3 
Li Hep 4.5 mL 
Orange 
LHN1 (5) 
Field Lab 

# National Diet And Nutrition Survey (Ndns) Nurse Visit

## Adult Consent Form (16+ Years)

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

SERIAL NUMBER 
CHECK LETTER 
RESPONDENT No. 


Please initial/tick boxes if consent given 
 
1. 
I confirm that I have read and understand the NDNS Nurse Visit information 
sheet(s) dated 05.02.2014 (version 2) for the above study. I have been given the opportunity to ask questions and have had these answered satisfactorily. 
 
2. 
I understand that my participation is voluntary and that I am free to withdraw from   any part of the study, at any time, without giving a reason and without my medical care or legal rights being affected.  

## Measurements 3. I Agree For My Blood Pressure Results To Be Sent To My Gp.

 4. 
I agree for my body mass index (BMI) measurement to be sent to my GP. 
 

# National Diet And Nutrition Survey (Ndns) Nurse Visit

## Adult Consent Form (16+ Years)

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

SERIAL NUMBER 
CHECK LETTER 
RESPONDENT No. 
Please initial/tick boxes if consent given 
BLOOD SAMPLE 
5. 
I agree to have a blood sample taken as part of the study. 6. 
I give permission that my blood sample taken as part of this study may be stored and, with ethical approval as appropriate, used in future research studies 7. 
I would like to receive my blood results which are clinically relevant. 8. 
I consent to my GP being notified of my blood results which are clinically  
 
 
relevant. 
9. 
You will be required to consent to the statement below if you do not want to receive your blood results AND if you do not want them sent to your GP. I confirm that against the advice of the NDNS survey team, I do not want to receive my blood results which are clinically relevant or have them sent to my GP. I understand that if there are findings outside of the normal range, this will not be brought to the attention of any health care provider. 

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

## Name Of Child

| 1.                                                                               |
|----------------------------------------------------------------------------------|
| read and understand the NDNS Nurse Visit information sheet(s) dated              |
| 05.02.2014 (version 2) for the above study. I have been given the opportunity to |
| ask questions and have had these answered satisfactorily.                        |

 2. 
I understand that my child's participation is voluntary and that s/he is free to withdraw from   any part of the study, at any time, without giving a reason and without my medical care or legal rights being affected.  

## Measurements 3. I Agree For My Child'S Blood Pressure Results To Be Sent To His/Her Gp. National Diet And Nutrition Survey (Ndns) Nurse Visit Parental/Guardian Consent For Child (4-15 Years)

MREC Reference Number: 13/EE/0016 

BLOOD SAMPLE 
4. 
I agree to my child having a blood sample taken as part of the study. 5. 
I give permission that my child's blood sample taken as part of this study may be stored and, with ethical approval as appropriate, used in future research studies 

6. 
I would like to receive my child's blood results which are clinically relevant. 7. 
I consent to my child's GP being notified of his/her blood results which are  
 
clinically relevant. 

8.
IF you do not want to receive your child's blood results AND if you do not want them sent to their GP, for us to take a blood sample from your child, you will be required to consent to both of the statements below. (i) 
I confirm that against the advice of the NDNS survey team, I do not want 
 
to receive my child's blood results which are clinically relevant or have 
|      | them                                                                     |
|------|--------------------------------------------------------------------------|
|      |                                                                          |
| (ii) | I agree to the survey doctor contacting me to discuss, if necessary, any |
results that are directly relevant to my child's health. 

# National Diet And Nutrition Survey (Ndns) Nurse Visit

## Child Assent Form (5-15 Years)

MREC Reference Number: 13/EE/0016 
Please use capital letters and write in ink  

RESPONDENT No. 
Please circle 
Yes / No 
1. 
Has somebody explained what happens at the nurse visit? 
 
Yes / No 2. 
Do you understand what this study is about?  
 
Yes / No 3. 
Have you asked all the questions you want? 
 
Yes / No 4. 
Have you had your questions answered in a way you understand? 
 
Yes / No 5. 
Do you understand it's OK to stop taking part at any time? 
 
Yes / No 6. 
Are you happy to take part? 

 If any answers are 'No' or you don't want to take part, don't sign your name! If you do want to take part, you can write your name below. Your name Date The nurse who explained this study to you needs to sign too: Nurse name Signature 
 
Thank you for helping us! 

MREC Reference Number: 13/EE/0016 

Name of Child 
 
| 1.                                                                               | I am the parent/guardian of the child named above and I confirm that I           |
|----------------------------------------------------------------------------------|----------------------------------------------------------------------------------|
| have read and understand the NDNS Nurse Visit information sheet(s) dated         |                                                                                  |
| 05.02.2014 (version 2) for the above study. I have been given the opportunity to |                                                                                  |
| ask questions and have had these answered satisfactorily.                        |                                                                                  |
|                                                                                  |                                                                                  |
| 2.                                                                               | I understand that my child's participation is voluntary and that s/he is free to |
|    |                                                          | withdraw from any part of the study, at any time, without giving a reason and    |
|----|----------------------------------------------------------|----------------------------------------------------------------------------------|
|    | without our medical care or legal rights being affected. |                                                                                  |

## Blood Sample

3. 
I agree to my child having a blood sample taken as part of the study. 4. 
I give permission that my child's blood sample taken as part of this study may be stored and, with ethical approval as appropriate, used in future research studies. 5. 
I would like to receive my child's blood results which are clinically relevant. 6. 
I consent to my child's GP being notified of his/her blood results which are  
 
clinically relevant. 
7. 
 
IF you do not want to receive your child's blood results AND if you do not want them sent to their GP, for us to take a blood sample from your child, you will be required to consent to both of the statements below. (i) 
I confirm that against the advice of the NDNS survey team, I do not want 
|      |                                                                          | to receive my child's blood results which are clinically relevant or have    |
|------|--------------------------------------------------------------------------|------------------------------------------------------------------------------|
|      | them                                                                     | sent to his/her GP.                                                          |
|      |                                                                          |                                                                              |
| (ii) | I agree to the survey doctor contacting me to discuss, if necessary, any |                                                                              |
|      | results that are directly relevant to my child's health.                 |                                                                              |

## Nurses - Fill In Yellow Section Only Volunteer Details Study Details

Consultant        Dr Sumantra Ray Location           Project 952 

## Affix

 Surname:     HNR _ _ _ _ _ _ _ _ _ _ _ _ _ _                                  
(use 10 digit ID at top of label) 
First name:   P952 

serial  
number  
label 
Title                 NDNS External ID:    EN1 _ _ _ _ _ _ _ _ _ _ _ _                    
(use 7 digit no. at bottom of EN1 label) 
 
  
Adx1(10) 
or 
Adx2 (11) 
  
DOB                   /         /                  **dd/mm/yyyy** 
Contact            HNR Switchboard 
                       01223 426356 
or 
Adx3 (12) 
 
Male 
 1 
                       Sonja Nicholson Karen Chamberlain 
                       Kate Guberg            
circle as appropriate 
  
Female 
 2 
Contact OOH    Dr Sumantra Ray 
                       0799 062 6671 

## Sample Details

Date 
/      / 
dd/mm/yyyy 
Volunteer Fasted 
Yes 
1 
circle as appropriate 
Time 
    : 
24hr clock 
  
No 
2 Sample Tube 
Tests 
Lab order 
Lab barcode 
Lab processing LAB90 
ENDO BARCODE 
HbA1C - print 2 labels 
Circle as appropriate 
 
Full tube 
BIOCHEM BARCODE Folate Store 
          - print 3 labels LAB6108 
Database search box will appear, click database lookup tab and select 
EDTA 
EN1 red 
Partial tube 
Label primary tube with FBC label and pass to Lab Staff for splitting of EDTA - instructions 
below 
FBC 
          -print 2 labels 
LAB294 
HAEM BARCODE 

## Edta Separation Depending On Sample Volume Split The Whole Blood In The Following Priority Fbc

Minimum volume required is 1ml - there will be three options: -  Volume less than 1ml (e.g. partial sample) proceed to folate aliquoting and cancel FBC adding comment: Insufficient sample for Haem in the cancellation comments and white box req comments field. 
-  Volume very close to 1ml send primary tube to Haem with the pink duplicate request form, cancel the HbA1c TEST adding the comment: Insufficient sample for HbA1c in the cancellation comments and white box 
req comments field. 
-  Volume more than ~1.5ml proceed to aliquoting whole blood for folate. 
  

## Folate

Take 2x 2ml tubes of ascorbic acid from the bottom half of the -80°C Protect freezer and defrost. Each  
contains 1ml ascorbic acid - check it has not expired. 
Label 2x defrosted 2ml ascorbic acid tubes with HNR barcode labels (FOL1 & FOL2) supplied in the delivery pack, Only label with patient biochem barcodes if there have been no HNR labels (FOL1 &| FOL2) sent.  
Invert the primary EDTA tube a few times to re-suspend the contents Transfer exactly 100µl from primary EDTA tube into each tube containing 1ml ascorbic acid and invert to mix Store in the -80°C Protect freezer 
If there is sufficient volume proceed to aliquoting whole blood for HbA1C then primary tube to Haem with the 
pink duplicate request form 
If there is insufficient volume left for HbA1C, cancel adding the comment: Insufficient sample for HbA1C in the 
cancellation comments and white box req comments field. 
HbA1C 
Label 1x 2ml secondary tube with Endo HbA1C barcode Invert the primary EDTA tube a few times to re-suspend the contents Transfer 0.5ml from primary EDTA tube into secondary tube 
Place secondary tube in HbA1C skip in office 

## National Diet And Nutrition Survey (Ndns) Adult Field Lab Despatch Note - 16+ Years Nurse Section

Sex: 
Male   /   Female 
Checklist 
  
  
Samples 
Fasted sample: 
Yes     /   No 
Labels 
  
Affix label 
Microtubes 
Sample 
collection date: 
DD / MM / YY 
FL1 (13) 
Despatch note 
here 
  
  
Sample 
collection time: 
HH  :  MM 
24 hr clock 
Affix label 
FL2 (14) 
on reverse 
Have you delivered all the items on the checklist  
to the field lab? 
   Yes   /   No 
Time samples delivered to field lab: 
HH  :  MM 
24 hr clock 

## Field Lab Section

| DD                                      | /    | MM    | /    |
|-----------------------------------------|------|-------|------|
|                                         |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
| Date sample arrived:                    |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
| HH                                      |      | :     | MM   |
|                                         |      |       |      |
| 24 hr clock                             |      |       |      |
|                                         |      |       |      |
| Time sample arrived:                    |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
|                                         |      |       |      |
| Blood Monovette Tubes                   |      |       |      |
|                                         |      |       |      |
| SEN1                                    |      |       |      |
|                                         |      |       |      |
| LHN1                                    |      |       |      |
|                                         |      |       |      |
| LHN2                                    |      |       |      |
|                                         |      |       |      |
| LHN3                                    |      |       |      |
|                                         |      |       |      |
| FN1                                     |      |       |      |
|                                         |      |       |      |
| EN2                                     |      |       |      |
|                                         |      |       |      |
| Sample received?                        |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Full /                                  |      |       |      |
|                                         |      |       |      |
| Full /                                  |      |       |      |
|                                         |      |       |      |
| Full /                                  |      |       |      |
|                                         |      |       |      |
| Full /                                  |      |       |      |
|                                         |      |       |      |
| Full /                                  |      |       |      |
|                                         |      |       |      |
| Is tube full or partial?                |      |       |      |
|                                         |      |       |      |
| Full /                                  |      |       |      |
|                                         |      |       |      |
| Partial                                 |      |       |      |
|                                         |      |       |      |
| Partial                                 |      |       |      |
|                                         |      |       |      |
| Partial                                 |      |       |      |
|                                         |      |       |      |
| Partial                                 |      |       |      |
|                                         |      |       |      |
| Partial                                 |      |       |      |
|                                         |      |       |      |
| Partial                                 |      |       |      |
|                                         |      |       |      |
| Is tube damaged?                        |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| Yes/No                                  |      |       |      |
|                                         |      |       |      |
| µl                                      |      |       |      |
|                                         |      |       |      |
| Volume aliquotted                       |      |       |      |
|                                         |      |       |      |
| Take 1300µl whole blood from well mixed |      |       |      |
|                                         |      |       |      |
| LHN3 tube.                              |      |       |      |
| HH:MM                                   |      |       |      |
|                                         |      |       |      |
| Time aliquotted                         |      |       |      |
|                                         |      |       |      |
| Use 2ml microtube.                      |      |       |      |
|                                         |      |       |      |
| Label with LHWB (15).                   |      |       |      |
|                                         |      |       |      |
| HH:MM                                   |      |       |      |
|                                         |      |       |      |
| Time in freezer                         |      |       |      |
|                                         |      |       |      |

## Centrifuge Tubes For 20Mins At 4°C And 2000G

Time tubes placed in 
the centrifuge 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
Did you use a refrigerated centrifuge? 
Yes   /   No 

If NO, explain here what you did to keep samples cool: 
  

here 
  
Blood Monovette Tubes 
SEN1 
LHN1 
LHN2 
LHN3 
FN1 
EN2 
Is sample normal? 
Yes/No 
Yes/No 
Yes/No 
Yes/No 
Yes/No 
Yes/No 
  
  
  
  
  
  
If NO, describe 
e.g. haemolysed, cloudy, clotted, not 
clotted (SEN1 only) 
Aliquot ALL plasma/serum unless otherwise stated; do not contaminate with cells 
Microtube size 
5ml 
5ml 
5ml 
5ml 
2ml 
2ml 
Attach label 
SERUM 
LIHEP1 
LIHEP2 
LIHEP3 
FLOX 
EDTA 
Time aliquotted: 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
µl 
Volume aliquotted 
Take EXACTLY 300µl plasma from 
LIHEP1. Use 2ml microtube with 
  
HH:MM 
Time aliquotted 
green lid containing MPA.  
Attach label LHMPA (18). 
HH:MM 
Time in freezer 
Time aliquots in freezer: 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
HH:MM 
HH:MM 

Wash red blood cells in monovettes LHN1, LHN2 and LHN3 using saline 3 times. After each wash,  
centrifuge for 10mins and then discard the supernatant. Place washed red blood cells in their original monovettes in the freezer. 

Time monovettes in 
freezer: 
  
HH:MM 
HH:MM 
HH:MM 
  
 
Storage Freezer temperature:  _        _°C 

Have you completed all relevant fields?         Yes   /   No 


Please fax/ email both sides of this despatch form after sample processing to HNR 
 
FAX: 01223 437546 
EMAIL: ndns.fieldlab@mrc-hnr.cam.ac.uk 
 
HNR will arrange for the collection of samples and these forms via courier 

# National Diet And Nutrition Survey (Ndns)

## Field Lab Despatch Note - 7 To 15 Years Nurse Section

Participant details 

|                                                   |     |
|---------------------------------------------------|-----|
|                                                   |     |
| Checklist                                         |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
| Sex:                                              |     |
|                                                   |     |
| Male   /   Female                                 |     |
|                                                   |     |
| Samples                                           |     |
|                                                   |     |
| Fasted sample:                                    |     |
|                                                   |     |
| Yes     /   No                                    |     |
|                                                   |     |
| Labels                                            |     |
|                                                   |     |
| Affix label                                       |     |
|                                                   |     |
| Microtubes                                        |     |
|                                                   |     |
| FL1 (13)                                          |     |
|                                                   |     |
| Sample                                            |     |
|                                                   |     |
| collection date:                                  |     |
|                                                   |     |
| DD                                                |     |
|                                                   |     |
| Despatch note                                     |     |
|                                                   |     |
| here                                              |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
| Affix label                                       |     |
|                                                   |     |
| Sample                                            |     |
|                                                   |     |
| collection time:                                  |     |
|                                                   |     |
| HH                                                |     |
|                                                   |     |
| FL2 (14) on                                       |     |
| reverse                                           |     |
|                                                   |     |
| Yes   /   No                                      |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
| Have you delivered all the items on the checklist |     |
| to the field lab?                                 |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
| Time samples delivered to field lab:              |     |
|                                                   |     |
| HH                                                | :   |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |
|                                                   |     |

## Field Lab Section

| DD                       |     | /    | MM    |
|--------------------------|-----|------|-------|
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
| Date sample arrived:     |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
| HH                       |     | :    | MM    |
|                          |     |      |       |
| 24 hr clock              |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
| Time sample arrived:     |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
| Blood Monovette Tubes    |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
|                          |     |      |       |
| SEN1                     |     |      |       |
|                          |     |      |       |
| LHN1                     |     |      |       |
|                          |     |      |       |
| LHN2                     |     |      |       |
|                          |     |      |       |
| FN1                      |     |      |       |
|                          |     |      |       |
| Sample received?         |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Is tube full or partial? |     |      |       |
|                          |     |      |       |
| Full / Partial           |     |      |       |
|                          |     |      |       |
| Full / Partial           |     |      |       |
|                          |     |      |       |
| Full / Partial           |     |      |       |
|                          |     |      |       |
| Full / Partial           |     |      |       |
|                          |     |      |       |
| Is tube damaged?         |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |
| Yes  /  No               |     |      |       |
|                          |     |      |       |

## Centrifuge Tubes For 20Mins At 4°C And 2000G

Time tubes placed in 
the centrifuge 
HH  :  MM 
HH  :  MM 
HH  :  MM 
HH  :  MM 
Did you use a refrigerated centrifuge?                                          **Yes   /   No** 
If NO, explain here what you did to keep samples cool: 
  
  
Blood Monovette Tubes 
SEN1 
LHN1 
LHN2 
FN1 
Is sample normal? 
Yes  /  No 
Yes  /  No 
Yes  /  No 
Yes  /  No 
  
  
  
  
If NO, describe 
e.g. haemolysed, cloudy, clotted, not  
clotted (SEN1 only) 
Aliquot ALL plasma/serum unless otherwise stated; do not contaminate with cells 
Microtube size 
5ml 
5ml 
5ml 
2ml 
Attach label 
SERUM 
LIHEP1 
LIHEP2 
FLOX 
Time aliquotted: 
HH  :  MM 
HH  :  MM 
HH  :  MM 
HH  :  MM 
µl 
Volume  
aliquotted 
Take EXACTLY 300µl plasma from LIHEP1. 
Use 2ml microtube with green lid  
  
HH  :  MM 
Time  
aliquotted 
containing MPA. Attach label LHMPA (18). 
HH  :  MM 
Time in freezer 
Time aliquots in freezer: 
HH  :  MM 
HH  :  MM 
HH  :  MM 
HH  :  MM 
Wash red blood cells in monovettes LHN1 and LHN2 using saline 3 times. After each wash,  
centrifuge for 10mins and then discard the supernatant. Place washed red blood cells in their original 
monovettes in the freezer. 
Time monovettes in 
freezer: 
  
HH  :  MM 
HH  :  MM 
  
 
 
Storage Freezer temperature:           °C Have you completed all relevant fields?          Yes   /   No 

Please fax/ email both sides of this despatch form after sample processing to HNR 
FAX: 01223 437546 
EMAIL: ndns.fieldlab@mrc-hnr.cam.ac.uk HNR will arrange for the collection of samples and these forms via courier 

# National Diet And Nutrition Survey (Ndns) Field Lab Despatch Note - 1.5 To 6 Years

## Nurse Section

Participant details 
            
Sex: 
Male   /   Female 
  
Checklist 
  
Samples Labels 
Fasted sample: 
Yes     /   No 
Affix label 
Microtubes 
Sample 
collection date: 
DD / MM / YY 
FL1 (13) 
  
Despatch note 
here 
  
  
  
  
Affix label 
Sample 
collection time: 
HH  :  MM   24 hr clock 
FL2 (14) 
on reverse 
Yes  /  No 
      
Have you delivered all the items on the checklist  
to the field lab? 
    
  
Time samples delivered to field lab:         HH  :  MM           ****          24 hr clock 
 

## Field Lab Section

| DD                                           |              | /                                                 | MM   |
|----------------------------------------------|--------------|---------------------------------------------------|------|
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
| Date sample arrived:                         |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
| HH                                           |              | :                                                 | MM   |
|                                              |              |                                                   |      |
| 24 hr clock                                  |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
| Time sample arrived:                         |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
| Blood Monovette Tubes                        |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
| SEN1                                         |              |                                                   |      |
|                                              |              |                                                   |      |
| LHN1                                         |              |                                                   |      |
|                                              |              |                                                   |      |
| Sample received?                             |              |                                                   |      |
|                                              |              |                                                   |      |
| Yes  /  No                                   |              |                                                   |      |
|                                              |              |                                                   |      |
| Yes  /  No                                   |              |                                                   |      |
|                                              |              |                                                   |      |
| Is tube full or partial?                     |              |                                                   |      |
|                                              |              |                                                   |      |
| Full  /  Partial                             |              |                                                   |      |
|                                              |              |                                                   |      |
| Full  /  Partial                             |              |                                                   |      |
|                                              |              |                                                   |      |
| Is tube damaged?                             |              |                                                   |      |
|                                              |              |                                                   |      |
| Yes  /  No                                   |              |                                                   |      |
|                                              |              |                                                   |      |
| Yes  /  No                                   |              |                                                   |      |
|                                              |              |                                                   |      |
| Centrifuge tubes for 20mins at 4°C and 2000g |              |                                                   |      |
|                                              |              |                                                   |      |
| Time tubes placed in the                     |              |                                                   |      |
| centrifuge                                   |              |                                                   |      |
|                                              |              |                                                   |      |
| HH  :  MM                                    |              |                                                   |      |
|                                              |              |                                                   |      |
| HH  :  MM                                    |              |                                                   |      |
|                                              |              |                                                   |      |
| Did you use a refrigerated centrifuge?       | Yes   /   No |                                                   |      |
|                                              |              |                                                   |      |
| If                                           | NO           | , explain here what you did to keep samples cool: |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |
|                                              |              |                                                   |      |

 
Describe here any problems or deviations from protocol: 

Affix label 
FL2 (14) 
here 
  
Blood Monovette Tubes 
SEN1 
LHN1 
Is sample normal? 
Yes  /  No 
Yes  /  No 
  
  
If NO, describe 
e.g. haemolysed, cloudy, clotted, not  
clotted (SEN1 only) 
Aliquot ALL plasma/serum unless otherwise stated; do not contaminate with cells 
Microtube size 
5ml 
5ml 
Attach label 
SERUM 
LIHEP1 
Time aliquotted: 
HH  :  MM 
HH  :  MM 
µl 
Volume aliquotted 
Take EXACTLY 300µl plasma from LIHEP1.  
Use 2ml microtube with green lid containing MPA.  
HH : MM 
Time aliquotted 
Attach label LHMPA (18). 
HH : MM 
Time in freezer 
Time aliquots in freezer: 
HH  :  MM 
HH  :  MM 
Wash red blood cells in monovette LHN1 using saline 3 times. After each wash, centrifuge for 10mins and 
then discard the supernatant. Place washed red blood cells in their original monovette in the freezer. 
Time monovette in  
freezer: 
  
HH  :  MM 
 
 
Storage Freezer temperature:           °C Have you completed all relevant fields?        **Yes  /  No** 

 
Please fax/ email both sides of this despatch form after sample processing to HNR 
 
FAX: 01223 437546 
EMAIL: ndns.fieldlab@mrc-hnr.cam.ac.uk 
 
HNR will arrange for the collection of samples and these forms via courier 
 

Please affix 
1. 
Participant 
OFFDESP (2) 
 
details 
label here 
2. 
Age group: 
16+ 
EDTA  
Serum  
Li Hep TM   
Li Hep TM 
Fluoride   Li Hep 
 EDTA 


EDTA  
Serum  
Li Hep TM   
Li Hep  
7-15 Fluoride 
 
18mths - 6 yrs  
EDTA  
Serum  
Li Hep 
  


DAY: 
MONTH: 
YEAR: 


3. 
Date blood sample taken: 
TIME 4. 
Time blood sample taken: 
: 


DAY: 
MONT
YEAR: 5. 
Date blood despatched to Addenbrookes: 

6. 

Did you experience any problems in taking the Venepuncture? If yes, please  

record these below and state what action you took. (PROMPTED FROM CAPI)