ID

16540

Beschrijving

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Physical Examination. Case Report Form (CRF)/Source Document templates were created for University of Wisconsin-Madison researchers. These templates are consistent with the FDA's CDASH (Clinical Data Acquisition Standards Harmonization) standards. The CDASH standards identify those elements that should be captured on a Case Report Form (CRF). The forms serve only as templates, and must be edited to meet the study data collection needs as described in the protocol.

Link

https://ictr.wisc.edu/CaseReptTempt

Trefwoorden

  1. 23-07-16 23-07-16 -
  2. 17-11-16 17-11-16 -
Geüploaded op

23 juli 2016

DOI

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Licentie

Creative Commons BY-NC 3.0

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Physical Examination: CRF Wisconsin Madison

Physical Examination: CRF Wisconsin Madison

Header
Beschrijving

Header

PI Name
Beschrijving

PI Name

Datatype

text

Protocol or IRB Number
Beschrijving

Protocol or IRB Number

Datatype

integer

Protocol Short Title
Beschrijving

Protocol Short Title

Datatype

text

Subject Initials
Beschrijving

Subject Initials

Datatype

text

Subject ID
Beschrijving

Subject ID

Datatype

text

Exam Date
Beschrijving

Exam Date

Datatype

date

Physical Examination
Beschrijving

Physical Examination

Time
Beschrijving

Time

Datatype

time

Physical Examination not performed
Beschrijving

Physical Examination not performed

Datatype

boolean

Visit Number
Beschrijving

Visit Number

Datatype

text

Body System
Beschrijving

Body System

Body system to be examined
Beschrijving

Body System

Datatype

text

Finding
Beschrijving

Finding

Datatype

text

Comments (required if Abnormal)
Beschrijving

Comments

Datatype

text

Clinically Significant
Beschrijving

Clinically Significant

Datatype

boolean

Other
Beschrijving

Other

Other (specify in Comments)
Beschrijving

Other

Datatype

text

Finding
Beschrijving

Finding

Datatype

text

Comments (required if Abnormal)
Beschrijving

Comments

Datatype

text

Clinically Significant
Beschrijving

Clinically Significant

Datatype

boolean

Additional notes
Beschrijving

Additional notes

Datatype

text

Physical Examination performed by
Beschrijving

Physical Examination performed by

Datatype

text

Principal Investigator Signature
Beschrijving

Principal Investigator Signature

Datatype

text

Date
Beschrijving

Date

Datatype

date

Similar models

Physical Examination: CRF Wisconsin Madison

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
PI Name
Item
PI Name
text
Protocol or IRB Number
Item
Protocol or IRB Number
integer
Protocol Short Title
Item
Protocol Short Title
text
Subject Initials
Item
Subject Initials
text
Subject ID
Item
Subject ID
text
Exam Date
Item
Exam Date
date
Item Group
Physical Examination
Time
Item
Time
time
Physical Examination not performed
Item
Physical Examination not performed
boolean
Item
Visit Number
text
Code List
Visit Number
CL Item
Visit # (1)
CL Item
Visit # (2)
CL Item
Visit # (3)
CL Item
Visit # (4)
CL Item
Visit # (5)
CL Item
Visit # (6)
Item Group
Body System
Body System
Item
Body system to be examined
text
Item
Finding
text
Code List
Finding
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not examined (3)
Comments
Item
Comments (required if Abnormal)
text
Clinically Significant
Item
Clinically Significant
boolean
Item Group
Other
Other
Item
Other (specify in Comments)
text
Item
Finding
text
Code List
Finding
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not examined (3)
Comments
Item
Comments (required if Abnormal)
text
Clinically Significant
Item
Clinically Significant
boolean
Additional notes
Item
Additional notes
text
Physical Examination performed by
Item
Physical Examination performed by
text
Principal Investigator Signature
Item
Principal Investigator Signature
text
Date
Item
Date
date

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