ID

18731

Beschrijving

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Medical History (General). 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

Versies (2)
  1. 22-07-16 22-07-16 -
  2. 17-11-16 17-11-16 -
Geüploaded op

17 november 2016

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Medical History (General): CRF Wisconsin Madison

Engels

Medical History (General): CRF Wisconsin Madison

1 Formulieren  
Header
Beschrijving

Header

PI Name
Beschrijving

PI Name

Datatype

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C1521895
Protocol or IRB Number
Beschrijving

Protocol or IRB Number

Datatype

integer

Alias
UMLS CUI [1]
C2348563
Protocol Short Title
Beschrijving

Protocol Short Title

Datatype

text

Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C1705824
Subject Initials
Beschrijving

Subject Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Subject ID
Beschrijving

Subject ID

Datatype

integer

Alias
UMLS CUI [1]
C2348585
Date
Beschrijving

Date

Datatype

date

Alias
UMLS CUI [1]
C0011008
Medical History (General)
Beschrijving

Medical History (General)

Insert body system being inquired about
Beschrijving

Body System

Datatype

text

Alias
UMLS CUI [1]
C0460002
Diagnosed condition
Beschrijving

Diagnosed condition

Datatype

boolean

Alias
UMLS CUI [1]
C0011900
Diagnosis/Condition/Surgery
Beschrijving

Diagnosis/Condition/Surgery

Datatype

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2]
C0543467
Onset Date or Year
Beschrijving

Onset Date or Year

Datatype

integer

Alias
UMLS CUI [1]
C0574845
UMLS CUI [2]
C3274945
Current Problem
Beschrijving

Current Problem

Datatype

boolean

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0521116
Other (specify)
Beschrijving

Other (specify)

Diagnosed condition
Beschrijving

Diagnosed condition

Datatype

boolean

Alias
UMLS CUI [1]
C0011900
Diagnosis/Condition/Surgery
Beschrijving

Diagnosis/Condition/Surgery

Datatype

text

Alias
UMLS CUI [1]
C0011900
UMLS CUI [2]
C0543467
Onset Date Or Year
Beschrijving

Onset Date Or Year

Datatype

integer

Alias
UMLS CUI [1]
C0574845
UMLS CUI [2]
C3274945
Current Problem
Beschrijving

Current Problem

Datatype

boolean

Alias
UMLS CUI [1,1]
C0033213
UMLS CUI [1,2]
C0521116
Additional Notes
Beschrijving

Additional Notes

Datatype

text

Alias
UMLS CUI [1]
C0947611
Medical History Not Obtained
Beschrijving

Medical History Not Obtained

Datatype

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C1882120
Medical History Obtained By
Beschrijving

Medical History Obtained By

Datatype

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C1301820
Terug naar het begin van de pagina

Similar models

Medical History (General): CRF Wisconsin Madison

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
PI Name
Item
PI Name
text
C0027365 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Protocol or IRB Number
Item
Protocol or IRB Number
integer
C2348563 (UMLS CUI [1])
Protocol Short Title
Item
Protocol Short Title
text
C2348563 (UMLS CUI [1,1])
C1705824 (UMLS CUI [1,2])
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item Group
Medical History (General)
Body System
Item
Insert body system being inquired about
text
C0460002 (UMLS CUI [1])
Diagnosed condition
Item
Diagnosed condition
boolean
C0011900 (UMLS CUI [1])
Diagnosis/Condition/Surgery
Item
Diagnosis/Condition/Surgery
text
C0011900 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Onset Date or Year
Item
Onset Date or Year
integer
C0574845 (UMLS CUI [1])
C3274945 (UMLS CUI [2])
Current Problem
Item
Current Problem
boolean
C0033213 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Item Group
Other (specify)
Diagnosed condition
Item
Diagnosed condition
boolean
C0011900 (UMLS CUI [1])
Diagnosis/Condition/Surgery
Item
Diagnosis/Condition/Surgery
text
C0011900 (UMLS CUI [1])
C0543467 (UMLS CUI [2])
Onset Date Or Year
Item
Onset Date Or Year
integer
C0574845 (UMLS CUI [1])
C3274945 (UMLS CUI [2])
Current Problem
Item
Current Problem
boolean
C0033213 (UMLS CUI [1,1])
C0521116 (UMLS CUI [1,2])
Additional Notes
Item
Additional Notes
text
C0947611 (UMLS CUI [1])
Medical History Not Obtained
Item
Medical History Not Obtained
boolean
C0262926 (UMLS CUI [1,1])
C1882120 (UMLS CUI [1,2])
Medical History Obtained By
Item
Medical History Obtained By
text
C0262926 (UMLS CUI [1,1])
C1301820 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial