Concomitant Medication - If Medical History section is included indications on Prior Medication page must correlate utilizing the same terminlogy. Indication on concomitant page must be recorded on the Adverse Events Page and expressed utilizing the same terminology. If a medication was marked continuing at the initial visit (On the Prior and Concomitant Medication Page), but has since had a dosage change or has been stopped, it must be recorded on this form as a change with the start and end date.
If "YES", please record all medications used below. Where appropriate, medical conditions should be recorded on the Adverse Events Form, utilizing the same terminology. If a medication has had a dosage change it must be recorded with the start and stop date.
boolean
Drug Name
text
Dose
text
Dose Frequency
text
Administration Route
text
Indication
text
Start Date - As a minimum the year must be started.
date
Start Time
time
End Date
date
End Time
time
Ongoing
boolean