Englisch

Case Report Form: overall appraisal of treatment

1 Formulare  
Appraisal by Investigator
Beschreibung

Appraisal by Investigator

Effectiveness of treatment in comparison to last years pollen season
Beschreibung

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

Datentyp

text

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

Tolerance

Datentyp

text

Alias
UMLS CUI [1]
C0231197
Appraisal by patient
Beschreibung

Appraisal by patient

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

Satisfaction with treatment

Datentyp

text

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

Recommendation

Datentyp

text

Alias
UMLS CUI [1]
C0034866
Date and Signature
Beschreibung

Date and Signature

Study completion form has been filled in
Beschreibung

Study completion form

Datentyp

boolean

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

Date

Datentyp

date

Alias
UMLS CUI [1]
C0011008
Signature
Beschreibung

Signature

Datentyp

text

Alias
UMLS CUI [1]
C1519316
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Ähnliche Modelle

Case Report Form: overall appraisal of treatment

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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])
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