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CABACS Case Report Form [follow up completion form]

1 forms  
Follow up completion
Description

Follow up completion

Patient ID
Description

Patient Study ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Study end date
Description

Study end date

Data type

date

Alias
UMLS CUI [1]
C2983670
Type of trial completion
Description

Type of trial completion

Data type

integer

Alias
UMLS CUI [1]
C2732579
If premature end of study, specify reason
Description

Premature end of study

Data type

integer

Alias
UMLS CUI [1]
C2732579
Please specify withdrawn IC, kind of comorbidity,death and other reasons for premature end of study
Description

Specification

Data type

text

Alias
UMLS CUI [1]
C2348235
Date of completion of this form
Description

Date of completion

Data type

date

Alias
UMLS CUI [1]
C0011008
Signature by investigator
Description

Signature

Data type

text

Alias
UMLS CUI [1]
C1519316
Name of Investigator
Description

Name of Investigator

Data type

text

Alias
UMLS CUI [1]
C0008961
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Similar models

CABACS Case Report Form [follow up completion form]

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Follow up completion
Patient Study ID
Item
Patient ID
text
C2348585 (UMLS CUI [1])
Study end date
Item
Study end date
date
C2983670 (UMLS CUI [1])
Item
Type of trial completion
integer
C2732579 (UMLS CUI [1])
Type of trial completion
Code List
Type of trial completion
CL Item
no follow-up, see completion clinical trial section (0)
CL Item
normal end of study (1)
CL Item
premature end of study (specify) (2)
Item
If premature end of study, specify reason
integer
C2732579 (UMLS CUI [1])
Premature end of study
Code List
If premature end of study, specify reason
CL Item
informed consent withdrawn (1)
CL Item
Patient unable to participate any more due to comorbidity, no legal representative  (2)
CL Item
lost to follow up (3)
CL Item
Death (Investigate further,fill in outcome event form) (4)
CL Item
other reason (5)
Specification
Item
Please specify withdrawn IC, kind of comorbidity,death and other reasons for premature end of study
text
C2348235 (UMLS CUI [1])
Date of completion
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature by investigator
text
C1519316 (UMLS CUI [1])
Name of Investigator
Item
Name of Investigator
text
C0008961 (UMLS CUI [1])
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