Engelsk

Physical Examination: 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

text

Exam Date
Beskrivning

Exam Date

Datatyp

date

Physical Examination
Beskrivning

Physical Examination

Time
Beskrivning

Time

Datatyp

time

Physical Examination not performed
Beskrivning

Physical Examination not performed

Datatyp

boolean

Visit Number
Beskrivning

Visit Number

Datatyp

text

Body System
Beskrivning

Body System

Body system to be examined
Beskrivning

Body System

Datatyp

text

Finding
Beskrivning

Finding

Datatyp

text

Comments (required if Abnormal)
Beskrivning

Comments

Datatyp

text

Clinically Significant
Beskrivning

Clinically Significant

Datatyp

boolean

Other
Beskrivning

Other

Other (specify in Comments)
Beskrivning

Other

Datatyp

text

Finding
Beskrivning

Finding

Datatyp

text

Comments (required if Abnormal)
Beskrivning

Comments

Datatyp

text

Clinically Significant
Beskrivning

Clinically Significant

Datatyp

boolean

Additional notes
Beskrivning

Additional notes

Datatyp

text

Physical Examination performed by
Beskrivning

Physical Examination performed by

Datatyp

text

Principal Investigator Signature
Beskrivning

Principal Investigator Signature

Datatyp

text

Date
Beskrivning

Date

Datatyp

date

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Similar models

Physical Examination: 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
text
Exam Date
Item
Exam Date
date
Item Group
Physical Examination
Time
Item
Time
time
Physical Examination not performed
Item
Physical Examination not performed
boolean
Item
Visit Number
text
Visit Number
Code List
Visit Number
CL Item
Visit # (1)
CL Item
Visit # (2)
CL Item
Visit # (3)
CL Item
Visit # (4)
CL Item
Visit # (5)
CL Item
Visit # (6)
Item Group
Body System
Body System
Item
Body system to be examined
text
Item
Finding
text
Finding
Code List
Finding
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not examined (3)
Comments
Item
Comments (required if Abnormal)
text
Clinically Significant
Item
Clinically Significant
boolean
Item Group
Other
Other
Item
Other (specify in Comments)
text
Item
Finding
text
Finding
Code List
Finding
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not examined (3)
Comments
Item
Comments (required if Abnormal)
text
Clinically Significant
Item
Clinically Significant
boolean
Additional notes
Item
Additional notes
text
Physical Examination performed by
Item
Physical Examination performed by
text
Principal Investigator Signature
Item
Principal Investigator Signature
text
Date
Item
Date
date
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