ID

16541

Descripción

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

Palabras clave

  1. 23/7/16 23/7/16 -
  2. 17/11/16 17/11/16 -
Subido en

23 de julio de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0

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Vital Sign Measurements (Standard): CRF Wisconsin Madison

Vital Sign Measurements (Standard): CRF Wisconsin Madison

Header
Descripción

Header

PI Name
Descripción

PI Name

Tipo de datos

text

Protocol or IRB Number
Descripción

Protocol or IRB Number

Tipo de datos

integer

Protocol Short Title
Descripción

Protocol Short Title

Tipo de datos

text

Subject Initials
Descripción

Subject Initials

Tipo de datos

text

Subject ID
Descripción

Subject ID

Tipo de datos

integer

Exam Date
Descripción

Exam Date

Tipo de datos

date

Vital Sign Measurements (Standard)
Descripción

Vital Sign Measurements (Standard)

Vital Sign Measurement not performed
Descripción

Vital Sign Measurement not performed

Tipo de datos

boolean

Visit Number
Descripción

Visit Number

Tipo de datos

text

Height
Descripción

Height

Tipo de datos

float

Unidades de medida
  • inches
inches
Height not measured
Descripción

Height

Tipo de datos

boolean

Weight
Descripción

Weight

Tipo de datos

float

Unidades de medida
  • lbs
lbs
Weight not measured
Descripción

Weight

Tipo de datos

boolean

Time
Descripción

Time

Tipo de datos

time

Temperature
Descripción

Temperature

Tipo de datos

float

Unidades de medida
  • Farenheit
Farenheit
Temperature not measured
Descripción

Temperature

Tipo de datos

boolean

Method
Descripción

Method

Tipo de datos

text

Respiratory Rate
Descripción

Respiratory Rate

Tipo de datos

integer

Unidades de medida
  • breaths/min
breaths/min
Respiratory Rate not measured
Descripción

Respiratory Rate

Tipo de datos

boolean

Heart Rate
Descripción

Heart Rate

Tipo de datos

integer

Unidades de medida
  • beats/min
beats/min
Heart Rate not measured
Descripción

Heart Rate

Tipo de datos

boolean

Systolic Blood Pressure
Descripción

Systolic Blood Pressure

Tipo de datos

integer

Unidades de medida
  • mmHg
mmHg
Blood Pressure not measured
Descripción

Systolic Blood Pressure

Tipo de datos

boolean

Diastolic Blood Pressure
Descripción

Diastolic Blood Pressure

Tipo de datos

integer

Unidades de medida
  • mmHg
mmHg
Method
Descripción

Method

Tipo de datos

text

Location
Descripción

Location

Tipo de datos

text

Position
Descripción

Position

Tipo de datos

text

Additional Notes
Descripción

Additional Notes

Tipo de datos

text

Vital Sign Measurements obtained by
Descripción

Vital Sign Measurements obtained by

Tipo de datos

text

Similar models

Vital Sign Measurements (Standard): CRF Wisconsin Madison

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
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
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
Code List
Method
CL Item
Manual (1)
CL Item
Automated (2)
Item
Location
text
Code List
Location
CL Item
Left Arm (1)
CL Item
Right Arm (2)
Item
Position
text
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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