ID

16541

Description

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Vital Sign Measurements (Standard). 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)
  1. 7/23/16 7/23/16 -
  2. 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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Vital Sign Measurements (Standard): CRF Wisconsin Madison

English

Vital Sign Measurements (Standard): CRF Wisconsin Madison

1 forms  
Header
Description

Header

PI Name
Description

PI Name

Data type

text

Protocol or IRB Number
Description

Protocol or IRB Number

Data type

integer

Protocol Short Title
Description

Protocol Short Title

Data type

text

Subject Initials
Description

Subject Initials

Data type

text

Subject ID
Description

Subject ID

Data type

integer

Exam Date
Description

Exam Date

Data type

date

Vital Sign Measurements (Standard)
Description

Vital Sign Measurements (Standard)

Vital Sign Measurement not performed
Description

Vital Sign Measurement not performed

Data type

boolean

Visit Number
Description

Visit Number

Data type

text

Height
Description

Height

Data type

float

Measurement units
  • inches
inches
Height not measured
Description

Height

Data type

boolean

Weight
Description

Weight

Data type

float

Measurement units
  • lbs
lbs
Weight not measured
Description

Weight

Data type

boolean

Time
Description

Time

Data type

time

Temperature
Description

Temperature

Data type

float

Measurement units
  • Farenheit
Farenheit
Temperature not measured
Description

Temperature

Data type

boolean

Method
Description

Method

Data type

text

Respiratory Rate
Description

Respiratory Rate

Data type

integer

Measurement units
  • breaths/min
breaths/min
Respiratory Rate not measured
Description

Respiratory Rate

Data type

boolean

Heart Rate
Description

Heart Rate

Data type

integer

Measurement units
  • beats/min
beats/min
Heart Rate not measured
Description

Heart Rate

Data type

boolean

Systolic Blood Pressure
Description

Systolic Blood Pressure

Data type

integer

Measurement units
  • mmHg
mmHg
Blood Pressure not measured
Description

Systolic Blood Pressure

Data type

boolean

Diastolic Blood Pressure
Description

Diastolic Blood Pressure

Data type

integer

Measurement units
  • mmHg
mmHg
Method
Description

Method

Data type

text

Location
Description

Location

Data type

text

Position
Description

Position

Data type

text

Additional Notes
Description

Additional Notes

Data type

text

Vital Sign Measurements obtained by
Description

Vital Sign Measurements obtained by

Data type

text

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Similar models

Vital Sign Measurements (Standard): CRF Wisconsin Madison

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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
Exam Date
Item
Exam Date
date
Item Group
Vital Sign Measurements (Standard)
Vital Sign Measurement not performed
Item
Vital Sign Measurement 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)
Height
Item
Height
float
Height
Item
Height not measured
boolean
Weight
Item
Weight
float
Weight
Item
Weight not measured
boolean
Time
Item
Time
time
Temperature
Item
Temperature
float
Temperature
Item
Temperature not measured
boolean
Item
Method
text
Method
Code List
Method
CL Item
Oral (1)
CL Item
Axillary (2)
CL Item
Tympanic (3)
Respiratory Rate
Item
Respiratory Rate
integer
Respiratory Rate
Item
Respiratory Rate not measured
boolean
Heart Rate
Item
Heart Rate
integer
Heart Rate
Item
Heart Rate not measured
boolean
Systolic Blood Pressure
Item
Systolic Blood Pressure
integer
Systolic Blood Pressure
Item
Blood Pressure not measured
boolean
Diastolic Blood Pressure
Item
Diastolic Blood Pressure
integer
Item
Method
text
Method
Code List
Method
CL Item
Manual (1)
CL Item
Automated (2)
Item
Location
text
Location
Code List
Location
CL Item
Left Arm (1)
CL Item
Right Arm (2)
Item
Position
text
Position
Code List
Position
CL Item
Sitting (1)
CL Item
Supine (2)
CL Item
Standing (3)
Additional Notes
Item
Additional Notes
text
Vital Sign Measurements obtained by
Item
Vital Sign Measurements obtained by
text
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