ID

16541

Beskrivning

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.

Länk

https://ictr.wisc.edu/CaseReptTempt

Nyckelord

Versioner (2)
  1. 2016-07-23 2016-07-23 -
  2. 2016-11-17 2016-11-17 -
Uppladdad den

23 juli 2016

DOI

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Licens

Creative Commons BY-NC 3.0
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Vital Sign Measurements (Standard): CRF Wisconsin Madison

Engelsk

Vital Sign Measurements (Standard): 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

Exam Date
Beskrivning

Exam Date

Datatyp

date

Vital Sign Measurements (Standard)
Beskrivning

Vital Sign Measurements (Standard)

Vital Sign Measurement not performed
Beskrivning

Vital Sign Measurement not performed

Datatyp

boolean

Visit Number
Beskrivning

Visit Number

Datatyp

text

Height
Beskrivning

Height

Datatyp

float

Måttenheter
  • inches
inches
Height not measured
Beskrivning

Height

Datatyp

boolean

Weight
Beskrivning

Weight

Datatyp

float

Måttenheter
  • lbs
lbs
Weight not measured
Beskrivning

Weight

Datatyp

boolean

Time
Beskrivning

Time

Datatyp

time

Temperature
Beskrivning

Temperature

Datatyp

float

Måttenheter
  • Farenheit
Farenheit
Temperature not measured
Beskrivning

Temperature

Datatyp

boolean

Method
Beskrivning

Method

Datatyp

text

Respiratory Rate
Beskrivning

Respiratory Rate

Datatyp

integer

Måttenheter
  • breaths/min
breaths/min
Respiratory Rate not measured
Beskrivning

Respiratory Rate

Datatyp

boolean

Heart Rate
Beskrivning

Heart Rate

Datatyp

integer

Måttenheter
  • beats/min
beats/min
Heart Rate not measured
Beskrivning

Heart Rate

Datatyp

boolean

Systolic Blood Pressure
Beskrivning

Systolic Blood Pressure

Datatyp

integer

Måttenheter
  • mmHg
mmHg
Blood Pressure not measured
Beskrivning

Systolic Blood Pressure

Datatyp

boolean

Diastolic Blood Pressure
Beskrivning

Diastolic Blood Pressure

Datatyp

integer

Måttenheter
  • mmHg
mmHg
Method
Beskrivning

Method

Datatyp

text

Location
Beskrivning

Location

Datatyp

text

Position
Beskrivning

Position

Datatyp

text

Additional Notes
Beskrivning

Additional Notes

Datatyp

text

Vital Sign Measurements obtained by
Beskrivning

Vital Sign Measurements obtained by

Datatyp

text

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Similar models

Vital Sign Measurements (Standard): 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
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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