ID

16611

Descripción

ODM Form derived from: https://ictr.wisc.edu/CaseReptTempt. Template Name: Device Accountability Log. 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

Versiones (4)
  1. 26/7/16 26/7/16 -
  2. 18/11/16 18/11/16 -
  3. 13/4/21 13/4/21 - Dr. rer. medic Philipp Neuhaus
  4. 17/11/21 17/11/21 -
Subido en

26 de julio de 2016

DOI

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Licencia

Creative Commons BY-NC 3.0
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Device Accountability Log: CRF Wisconsin Madison

Inglés

Device Accountability Log: CRF Wisconsin Madison

1 formularios  
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

Number of Page
Descripción

Number of Page

Tipo de datos

integer

Total amount of pages
Descripción

Total amount of pages

Tipo de datos

integer

Device Accountability Log: Device Receipt
Descripción

Device Accountability Log: Device Receipt

Date Received
Descripción

Date Received

Tipo de datos

date

Batch # or Device Type
Descripción

Batch # or Device Type

Tipo de datos

text

Lot #, Serial #, or Model Number(s)
Descripción

Lot #, Serial #, or Model Number(s)

Tipo de datos

integer

Received by (staff initials)
Descripción

Received by (staff initials)

Tipo de datos

text

Device Accountability Log: Device Use
Descripción

Device Accountability Log: Device Use

Date used
Descripción

Date used

Tipo de datos

date

Subject Study ID
Descripción

Subject Study ID

Tipo de datos

integer

Dispensed by (staff initials)
Descripción

Dispensed by (staff initials)

Tipo de datos

text

Device Accountability Log: Device Return/Repair/Destruction
Descripción

Device Accountability Log: Device Return/Repair/Destruction

Device Position
Descripción

RET = Returned DES = Destroyed REP = Repaired

Tipo de datos

text

Date of final Device Disposition
Descripción

Date of final Device Disposition

Tipo de datos

date

Reason
Descripción

Reason

Tipo de datos

text

Confirmed by (staff initials)
Descripción

Confirmed by (staff initials)

Tipo de datos

text

Comments
Descripción

Comments

Tipo de datos

text

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Similar models

Device Accountability Log: CRF Wisconsin Madison

1 formularios
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
Number of Page
Item
Number of Page
integer
Total amount of pages
Item
Total amount of pages
integer
Item Group
Device Accountability Log: Device Receipt
Date Received
Item
Date Received
date
Batch # or Device Type
Item
Batch # or Device Type
text
Lot #, Serial #, or Model Number(s)
Item
Lot #, Serial #, or Model Number(s)
integer
Received by (staff initials)
Item
Received by (staff initials)
text
Item Group
Device Accountability Log: Device Use
Date used
Item
Date used
date
Subject Study ID
Item
Subject Study ID
integer
Dispensed by (staff initials)
Item
Dispensed by (staff initials)
text
Item Group
Device Accountability Log: Device Return/Repair/Destruction
Device Position
Item
Device Position
text
Date of final Device Disposition
Item
Date of final Device Disposition
date
Reason
Item
Reason
text
Confirmed by (staff initials)
Item
Confirmed by (staff initials)
text
Comments
Item
Comments
text
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