ID
16966
Description
ODM derived from: http://research.uic.edu/qip/toolbox/case-report-forms-crf. Template Name: Prior and Concomitant Medications. QIP Case Report Forms, UIC Quality Improvement CRF, Office of the Vice Chancellor for Research. Center for Clinical and Translational Science, UIC University of Illinois at Chicago.
Link
http://research.uic.edu/qip/toolbox/case-report-forms-crf
Keywords
Versions (1)
- 8/17/16 8/17/16 -
Uploaded on
August 17, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Prior and Concomitant Medications: UIC Quality Improvement CRF
Prior and Concomitant Medications: UIC Quality Improvement CRF
- StudyEvent: ODM
Description
Medications
Description
Medication
Data type
text
Description
Dose
Data type
text
Description
1= oral 2= intravenous 3= subcutaneous 4= topical 5= inhalation 6= transdermal 7= rectal 8= intramuscular 9= sublingual 10= PEG 11= Other (specify)
Data type
integer
Description
Route
Data type
text
Description
1= Daily 2= BID 3= TID 4= QID 5= QHS 6= CONT IV 7= PRN 8= Other (specify)
Data type
integer
Description
Frequency
Data type
text
Description
Indication
Data type
text
Description
Start Date
Data type
date
Description
Stop Date
Data type
date
Description
AE Treatment
Data type
text
Description
Specification
Data type
text
Similar models
Prior and Concomitant Medications: UIC Quality Improvement CRF
- StudyEvent: ODM