ID

16195

Beschreibung

NCT02669589 EudraCT-Nr. 2014-004854-33 REGIONAL CITRATE VERSUS SYSTEMIC HEPARIN ANTICOAGULATION FOR CONTINUOUS RENAL REPLACEMENT THERAPY IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY Study Chair: Alexander Zarbock, MD University Hospital Muenster

Stichworte

Versionen (1)
  1. 04.07.16 04.07.16 -
Hochgeladen am

4. Juli 2016

DOI

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Creative Commons BY-NC-ND 3.0
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Consent RICH study NCT02669589

Englisch

Consent RICH study NCT02669589

1 Formulare  
Patient Information
Beschreibung

Patient Information

Alias
UMLS CUI-1
C1955348
ID of Center
Beschreibung

Center ID

Datentyp

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
ID of patient
Beschreibung

Patient ID

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Subsequent consent - please fill in for patients who are primary not able to give consent
Beschreibung

Subsequent consent - please fill in for patients who are primary not able to give consent

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C0332282
Subsequent consent given by patient (has the patient given written consent for participation to clinical trial subsequently?)
Beschreibung

Subsequent consent given by patient

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0332282
UMLS CUI [1,3]
C0030705
If patient gave subsequent consent, specify date:
Beschreibung

Date of subsequent consent given by patient

Datentyp

date

Alias
UMLS CUI [1,1]
C0332282
UMLS CUI [1,2]
C0030705
UMLS CUI [1,3]
C2985782
Subsequent consent given by representative (has the representative given written consent for participation to clinical trial subsequently?)
Beschreibung

Subsequent consent given by representative

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0332282
UMLS CUI [1,3]
C0030701
If representative gave subsequent consent, specify date:
Beschreibung

Date of subsequent consent given by representative

Datentyp

date

Alias
UMLS CUI [1,1]
C0332282
UMLS CUI [1,2]
C0030701
UMLS CUI [1,3]
C2985782
Lawsuit for legal caregiver applied?
Beschreibung

Lawsuit: caregiver

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0085537
UMLS CUI [1,2]
C2136079
Lawsuit for legal caregiver: If yes, completed?
Beschreibung

Lawsuit completed: caregiver

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0085537
UMLS CUI [1,2]
C2136079
UMLS CUI [1,3]
C0205197
Date of deployment of caregiver:
Beschreibung

Date of deployment of caregiver

Datentyp

date

Alias
UMLS CUI [1,1]
C0085537
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C2825812
Subsequent consent given by caregiver (has the caregiver given written consent for participation to clinical trial subsequently?)
Beschreibung

Subsequent consent given by caregiver

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C0332282
UMLS CUI [1,3]
C0085537
If caregiver gave subsequent consent, specify date:
Beschreibung

Date of subsequent consent given by caregiver

Datentyp

date

Alias
UMLS CUI [1,1]
C0332282
UMLS CUI [1,2]
C0085537
UMLS CUI [1,3]
C2985782
Withdrawal of consent
Beschreibung

Withdrawal of consent

Alias
UMLS CUI-1
C2349954
UMLS CUI-2
C0021430
Withdrawal of consent (fill in, if patients wants withdrawal of consent)
Beschreibung

Withdrawal of consent

Datentyp

boolean

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0021430
Reason for withdrawal of consent: (fill in, if patients wants withdrawal of consent)
Beschreibung

Reason for withdrawal of consent

Datentyp

text

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0392360
Date of withdrawal of consent by patient (fill in, if patients wants withdrawal of consent)
Beschreibung

Date of withdrawal of consent by patient

Datentyp

date

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0011008
UMLS CUI [1,4]
C0030705
Date of withdrawal of consent by representative (fill in, if representative wants withdrawal of consent)
Beschreibung

Date of withdrawal of consent by representative

Datentyp

date

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0011008
UMLS CUI [1,4]
C0030701
Date of withdrawal of consent by caregiver (fill in, if caregiver wants withdrawal of consent)
Beschreibung

Date of withdrawal of consent by caregiver

Datentyp

date

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0021430
UMLS CUI [1,3]
C0011008
UMLS CUI [1,4]
C2985782
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Ähnliche Modelle

Consent RICH study NCT02669589

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Center ID
Item
ID of Center
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient ID
Item
ID of patient
text
C2348585 (UMLS CUI [1])
Item Group
Subsequent consent - please fill in for patients who are primary not able to give consent
C0021430 (UMLS CUI-1)
C0332282 (UMLS CUI-2)
Subsequent consent given by patient
Item
Subsequent consent given by patient (has the patient given written consent for participation to clinical trial subsequently?)
boolean
C0021430 (UMLS CUI [1,1])
C0332282 (UMLS CUI [1,2])
C0030705 (UMLS CUI [1,3])
Date of subsequent consent given by patient
Item
If patient gave subsequent consent, specify date:
date
C0332282 (UMLS CUI [1,1])
C0030705 (UMLS CUI [1,2])
C2985782 (UMLS CUI [1,3])
Subsequent consent given by representative
Item
Subsequent consent given by representative (has the representative given written consent for participation to clinical trial subsequently?)
boolean
C0021430 (UMLS CUI [1,1])
C0332282 (UMLS CUI [1,2])
C0030701 (UMLS CUI [1,3])
Date of subsequent consent given by representative
Item
If representative gave subsequent consent, specify date:
date
C0332282 (UMLS CUI [1,1])
C0030701 (UMLS CUI [1,2])
C2985782 (UMLS CUI [1,3])
Lawsuit: caregiver
Item
Lawsuit for legal caregiver applied?
boolean
C0085537 (UMLS CUI [1,1])
C2136079 (UMLS CUI [1,2])
Lawsuit completed: caregiver
Item
Lawsuit for legal caregiver: If yes, completed?
boolean
C0085537 (UMLS CUI [1,1])
C2136079 (UMLS CUI [1,2])
C0205197 (UMLS CUI [1,3])
Date of deployment of caregiver
Item
Date of deployment of caregiver:
date
C0085537 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C2825812 (UMLS CUI [1,3])
Subsequent consent given by caregiver
Item
Subsequent consent given by caregiver (has the caregiver given written consent for participation to clinical trial subsequently?)
boolean
C0021430 (UMLS CUI [1,1])
C0332282 (UMLS CUI [1,2])
C0085537 (UMLS CUI [1,3])
Date of subsequent consent given by caregiver
Item
If caregiver gave subsequent consent, specify date:
date
C0332282 (UMLS CUI [1,1])
C0085537 (UMLS CUI [1,2])
C2985782 (UMLS CUI [1,3])
Item Group
Withdrawal of consent
C2349954 (UMLS CUI-1)
C0021430 (UMLS CUI-2)
Withdrawal of consent
Item
Withdrawal of consent (fill in, if patients wants withdrawal of consent)
boolean
C2349954 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
Reason for withdrawal of consent
Item
Reason for withdrawal of consent: (fill in, if patients wants withdrawal of consent)
text
C2349954 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Date of withdrawal of consent by patient
Item
Date of withdrawal of consent by patient (fill in, if patients wants withdrawal of consent)
date
C2349954 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C0030705 (UMLS CUI [1,4])
Date of withdrawal of consent by representative
Item
Date of withdrawal of consent by representative (fill in, if representative wants withdrawal of consent)
date
C2349954 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C0030701 (UMLS CUI [1,4])
Date of withdrawal of consent by caregiver
Item
Date of withdrawal of consent by caregiver (fill in, if caregiver wants withdrawal of consent)
date
C2349954 (UMLS CUI [1,1])
C0021430 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C2985782 (UMLS CUI [1,4])
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