Engelsk

Medical History (General): CRF Wisconsin Madison

1 Formulär  
Header
Beskrivning

Header

PI Name
Beskrivning

PI Name

Datatyp

text

Protocol or IRB Number
Beskrivning

Protocol or IRB Number

Datatyp

integer

Protocol Short Title
Beskrivning

Protocol Short Title

Datatyp

text

Subject Initials
Beskrivning

Subject Initials

Datatyp

text

Subject ID
Beskrivning

Subject ID

Datatyp

integer

Date
Beskrivning

Date

Datatyp

date

Medical History (General)
Beskrivning

Medical History (General)

Insert body system being inquired about
Beskrivning

Body System

Datatyp

text

Diagnosed condition
Beskrivning

Diagnosed condition

Datatyp

boolean

Diagnosis/Condition/Surgery
Beskrivning

Diagnosis/Condition/Surgery

Datatyp

text

Onset Date or Year
Beskrivning

Onset Date or Year

Datatyp

integer

Current Problem
Beskrivning

Current Problem

Datatyp

boolean

Other (specify)
Beskrivning

Other (specify)

Diagnosed condition
Beskrivning

Diagnosed condition

Datatyp

boolean

Diagnosis/Condition/Surgery
Beskrivning

Diagnosis/Condition/Surgery

Datatyp

text

Onset Date Or Year
Beskrivning

Onset Date Or Year

Datatyp

integer

Current Problem
Beskrivning

Current Problem

Datatyp

boolean

Additional Notes
Beskrivning

Additional Notes

Datatyp

text

Medical History Not Obtained
Beskrivning

Medical History Not Obtained

Datatyp

boolean

Medical History Obtained By
Beskrivning

Medical History Obtained By

Datatyp

text

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Similar models

Medical History (General): CRF Wisconsin Madison

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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
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