Inglés

Medical History (General): CRF Wisconsin Madison

1 formularios  
Header
Descripción

Header

PI Name
Descripción

PI Name

Tipo de datos

text

Protocol or IRB Number
Descripción

Protocol or IRB Number

Tipo de datos

integer

Protocol Short Title
Descripción

Protocol Short Title

Tipo de datos

text

Subject Initials
Descripción

Subject Initials

Tipo de datos

text

Subject ID
Descripción

Subject ID

Tipo de datos

integer

Date
Descripción

Date

Tipo de datos

date

Medical History (General)
Descripción

Medical History (General)

Insert body system being inquired about
Descripción

Body System

Tipo de datos

text

Diagnosed condition
Descripción

Diagnosed condition

Tipo de datos

boolean

Diagnosis/Condition/Surgery
Descripción

Diagnosis/Condition/Surgery

Tipo de datos

text

Onset Date or Year
Descripción

Onset Date or Year

Tipo de datos

integer

Current Problem
Descripción

Current Problem

Tipo de datos

boolean

Other (specify)
Descripción

Other (specify)

Diagnosed condition
Descripción

Diagnosed condition

Tipo de datos

boolean

Diagnosis/Condition/Surgery
Descripción

Diagnosis/Condition/Surgery

Tipo de datos

text

Onset Date Or Year
Descripción

Onset Date Or Year

Tipo de datos

integer

Current Problem
Descripción

Current Problem

Tipo de datos

boolean

Additional Notes
Descripción

Additional Notes

Tipo de datos

text

Medical History Not Obtained
Descripción

Medical History Not Obtained

Tipo de datos

boolean

Medical History Obtained By
Descripción

Medical History Obtained By

Tipo de datos

text

Volver a la parte superior de la página

Similar models

Medical History (General): CRF Wisconsin Madison

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
PI Name
Item
PI Name
text
Protocol or IRB Number
Item
Protocol or IRB Number
integer
Protocol Short Title
Item
Protocol Short Title
text
Subject Initials
Item
Subject Initials
text
Subject ID
Item
Subject ID
integer
Date
Item
Date
date
Item Group
Medical History (General)
Body System
Item
Insert body system being inquired about
text
Diagnosed condition
Item
Diagnosed condition
boolean
Diagnosis/Condition/Surgery
Item
Diagnosis/Condition/Surgery
text
Onset Date or Year
Item
Onset Date or Year
integer
Current Problem
Item
Current Problem
boolean
Item Group
Other (specify)
Diagnosed condition
Item
Diagnosed condition
boolean
Diagnosis/Condition/Surgery
Item
Diagnosis/Condition/Surgery
text
Onset Date Or Year
Item
integer
Current Problem
Item
Current Problem
boolean
Additional Notes
Item
Additional Notes
text
Medical History Not Obtained
Item
Medical History Not Obtained
boolean
Medical History Obtained By
Item
Medical History Obtained By
text
Volver a la parte superior de la página