Engelsk

Case Report Form: overall appraisal of treatment

1 Formulär  
Appraisal by Investigator
Beskrivning

Appraisal by Investigator

Effectiveness of treatment in comparison to last years pollen season
Beskrivning

Please note your professional opinion regarding treatment success. Please take into consideration the severity of symptoms of last years pollen season as well as other medical conditions of your patient

Datatyp

text

Alias
UMLS CUI [1]
C0087113
General tolerance of trial substance
Beskrivning

Tolerance

Datatyp

text

Alias
UMLS CUI [1]
C0231197
Appraisal by patient
Beskrivning

Appraisal by patient

Please rate your satisfaction with the resulting desensitization by the investigational agent
Beskrivning

Satisfaction with treatment

Datatyp

text

Alias
UMLS CUI [1,1]
C0242428
UMLS CUI [1,2]
C0949266
Would you recommend this treatment of specific desensitization to other patients?
Beskrivning

Recommendation

Datatyp

text

Alias
UMLS CUI [1]
C0034866
Date and Signature
Beskrivning

Date and Signature

Study completion form has been filled in
Beskrivning

Study completion form

Datatyp

boolean

Alias
UMLS CUI [1,1]
C1547674
UMLS CUI [1,2]
C0008976
Date of completion of this form
Beskrivning

Date

Datatyp

date

Alias
UMLS CUI [1]
C0011008
Signature
Beskrivning

Signature

Datatyp

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Case Report Form: overall appraisal of treatment

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Appraisal by Investigator
Item
Effectiveness of treatment in comparison to last years pollen season
text
C0087113 (UMLS CUI [1])
Efficacy of treatment
Code List
Effectiveness of treatment in comparison to last years pollen season
CL Item
deteriorated condition (0)
CL Item
no change in condition (1)
CL Item
little to moderate improvement (2)
CL Item
distinct to very pronounced improvement (3)
Item
General tolerance of trial substance
text
C0231197 (UMLS CUI [1])
Tolerance
Code List
General tolerance of trial substance
CL Item
poor (0)
CL Item
moderate (1)
CL Item
good (2)
CL Item
very good (3)
Item Group
Appraisal by patient
Item
Please rate your satisfaction with the resulting desensitization by the investigational agent
text
C0242428 (UMLS CUI [1,1])
C0949266 (UMLS CUI [1,2])
Satisfaction with treatment
Code List
Please rate your satisfaction with the resulting desensitization by the investigational agent
CL Item
not at all satisfied (0)
CL Item
less satisfied (1)
CL Item
satisfied (2)
CL Item
very satisfied (3)
Item
Would you recommend this treatment of specific desensitization to other patients?
text
C0034866 (UMLS CUI [1])
Recommendation
Code List
Would you recommend this treatment of specific desensitization to other patients?
CL Item
I certainly wouldn´t recommend this treatment (0)
CL Item
I probably wouldn´t recommend this treatment (1)
CL Item
I probably would recommend this treatment (2)
CL Item
I certainly would recommend this treatment (3)
Item Group
Date and Signature
Study completion form
Item
Study completion form has been filled in
boolean
C1547674 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
Date
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
Tillbaka till toppen