ID
16538
Description
ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Concomitant Medication Log. Case Report Form (CRF)/Source Document templates were created for University of Wisconsin-Madison researchers. These templates are consistent with the FDA's CDASH (Clinical Data Acquisition Standards Harmonization) standards. The CDASH standards identify those elements that should be captured on a Case Report Form (CRF). The forms serve only as templates, and must be edited to meet the study data collection needs as described in the protocol.
Link
https://ictr.wisc.edu/CaseReptTempt
Keywords
Versions (2)
- 7/23/16 7/23/16 -
- 11/17/16 11/17/16 -
Uploaded on
July 23, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Concomitant Medication Log: CRF Wisconsin Madison
Concomitant Medication Log: CRF Wisconsin Madison
- StudyEvent: ODM
Description
Concomitant Medication Log
Description
#
Data type
integer
Description
Medication/ Non-drug Therapy
Data type
text
Description
Indication
Data type
text
Description
Dose (per admin)
Data type
float
Description
1= g 2= mg 3= ug 4= L 5= mL 6= IU 7= Other
Data type
text
Description
1= QD (once a day) 2= BID (twice a day) 3= TID (three times a day) 4= QID (four times a day) 5= QOD (every other day) 6= QM (every month) 7= QOM (every other month) 8= QH (every hour) 9= AC (before meals) 10= PC (after meals) 11= PRN (as needed) 12= Other
Data type
text
Description
1= Tablet 2= Capsule 3= Ointment 4=Suppository 5=Aerosol 6=Spray 7=Suspension 8= Patch 9=Gas 10=Gel 11=Cream 12=Powder
Data type
text
Description
1= Oral 2= Topical 3= Subcutaneous 4= Intradermal 5= Transdermal 6= Intraocular 7= Intramuscular 8= Inhalation 9= Intravenous 10= Intraperitoneal 11= Nasal 12= Vaginal 13= Rectal 14= Other
Data type
text
Description
Start Date
Data type
date
Description
End Date
Data type
date
Description
Baseline Med
Data type
boolean
Description
Continuing at end of study
Data type
boolean
Similar models
Concomitant Medication Log: CRF Wisconsin Madison
- StudyEvent: ODM
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