Engels

Concomitant Medication Log: CRF Wisconsin Madison

1 Formulieren  
Header
Beschrijving

Header

PI Name
Beschrijving

PI Name

Datatype

text

Protocol or IRB Number
Beschrijving

Protocol or IRB Number

Datatype

integer

Protocol Short Title
Beschrijving

Protocol Short Title

Datatype

text

Subject Initials
Beschrijving

Subject Initials

Datatype

text

Subject ID
Beschrijving

Subject ID

Datatype

integer

Number of Page
Beschrijving

Number of Page

Datatype

integer

Total amount of pages
Beschrijving

Total amount of pages

Datatype

integer

Concomitant Medication Log
Beschrijving

Concomitant Medication Log

#
Beschrijving

#

Datatype

integer

Medication/ Non-drug Therapy
Beschrijving

Medication/ Non-drug Therapy

Datatype

text

Indication
Beschrijving

Indication

Datatype

text

Dose (per admin)
Beschrijving

Dose (per admin)

Datatype

float

Dose Units
Beschrijving

1= g 2= mg 3= ug 4= L 5= mL 6= IU 7= Other

Datatype

text

Schedule/Frequency
Beschrijving

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

Datatype

text

Dose Form
Beschrijving

1= Tablet 2= Capsule 3= Ointment 4=Suppository 5=Aerosol 6=Spray 7=Suspension 8= Patch 9=Gas 10=Gel 11=Cream 12=Powder

Datatype

text

Route of Administration
Beschrijving

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

Datatype

text

Start Date
Beschrijving

Start Date

Datatype

date

End Date
Beschrijving

End Date

Datatype

date

Baseline Med
Beschrijving

Baseline Med

Datatype

boolean

Continuing at end of study
Beschrijving

Continuing at end of study

Datatype

boolean

Terug naar het begin van de pagina

Similar models

Concomitant Medication Log: CRF Wisconsin Madison

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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
Number of Page
Item
Number of Page
integer
Total amount of pages
Item
Total amount of pages
integer
Item Group
Concomitant Medication Log
#
Item
#
integer
Medication/ Non-drug Therapy
Item
Medication/ Non-drug Therapy
text
Indication
Item
Indication
text
Dose (per admin)
Item
Dose (per admin)
float
Dose Units
Item
Dose Units
text
Schedule/Frequency
Item
Schedule/Frequency
text
Dose Form
Item
Dose Form
text
Route of Administration
Item
Route of Administration
text
Start Date
Item
Start Date
date
End Date
Item
End Date
date
Baseline Med
Item
Baseline Med
boolean
Continuing at end of study
Item
Continuing at end of study
boolean
Terug naar het begin van de pagina