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Details

Concomitant Medication Multiple Sclerosis ALAIN01 NCT02419378

1 forms

StudyEvent: SE
1. Concomitant Medication Multiple Sclerosis ALAIN01 NCT02419378

Name

Type

Description | Question | Decode (Coded Value)

Data type

Alias

Concomitant Medication

Item Group

Con. Med.

C2347852 (UMLS CUI-1)

Patient ID (derived)

Item

Patient ID (derived)

text

C2348585 (UMLS CUI [1])

Concomitant Medication: Sheet No

Item

integer

Concomitant Med.: Date of Signature

Item

date

Concomitant Med.: Date of Signature Status

Item

text

Concomitant Med.: Date of Signature Status

Code List

Concomitant Med.: Date of Signature Status

CL Item

T (1)

CL Item

TM (2)

CL Item

M (3)

Concomitant Med.: Signature yes/no

Item

text

Concomitant Med.: Signature yes/no

Code List

Concomitant Med.: Signature yes/no

CL Item

yes (1)

CL Item

no (0)

Concomitant Medication: New eForm

Item

text

Concomitant Medication: New eForm

Code List

Concomitant Medication: New eForm

CL Item

yes (1)

Comment Con. Med.

Item

text

Concomitant Medication

Item Group

Concomitant Medication RQG

C2347852 (UMLS CUI-1)

Concomitant Medication

Item

Concomitant Medication: Generic Name/Trade Name

text

C2347852 (UMLS CUI [1])

Concomitant Medication Use Indication

Item

Concomitant Medication: Indication

text

C2826696 (UMLS CUI [1])

Concomitant Medication Dose Morning

Item

Concomitant Medication: Dose Morning

text

C2826811 (UMLS CUI [1,1])

Concomitant Medication Dose Noon

Item

Concomitant Medication: Dose Noon

text

C2826811 (UMLS CUI [1])

Concomitant Medication Dose Evening

Item

Concomitant Medication: Dose Evening

text

C2826811 (UMLS CUI [1])

Concomitant Medication Dose Bed

Item

Concomitant Medication: Dose Bed

text

C2826811 (UMLS CUI [1])

Concomitant Medication Start Date

Item

Concomitant Medication: Start Date

date

C2826734 (UMLS CUI [1])

Concomitant Medication: Start Date Status

Item

text

Concomitant Medication: Start Date Status

Code List

Concomitant Medication: Start Date Status

CL Item

T (1)

CL Item

TM (2)

CL Item

M (3)

Concomitant Medication End Date

Item

Concomitant Medication: End Date

date

C2826744 (UMLS CUI [1])

Concomitant Medication: End Date Status

Item

text

Concomitant Medication: End Date Status

Code List

Concomitant Medication: End Date Status

CL Item

T (1)

CL Item

TM (2)

CL Item

M (3)

Concomitant Medication Ongoing

Item

Concomitant Medication: ongoing

text

C2826666 (UMLS CUI [1])

Concomitant Medication: ongoing

Code List

Concomitant Medication: ongoing

CL Item

ongoing (1)

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