ID

16611

Beschrijving

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

Trefwoorden

Versies (4)
  1. 26-07-16 26-07-16 -
  2. 18-11-16 18-11-16 -
  3. 13-04-21 13-04-21 - Dr. rer. medic Philipp Neuhaus
  4. 17-11-21 17-11-21 -
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26 juli 2016

DOI

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Licentie

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

Engels

Device Accountability Log: CRF Wisconsin Madison

1 Formulieren  
Header
Beschrijving

Header

PI Name
Beschrijving

PI Name

Datatype

text

Protocol or IRB Number
Beschrijving

Protocol or IRB Number

Datatype

integer

Protocol Short Title
Beschrijving

Protocol Short Title

Datatype

text

Number of Page
Beschrijving

Number of Page

Datatype

integer

Total amount of pages
Beschrijving

Total amount of pages

Datatype

integer

Device Accountability Log: Device Receipt
Beschrijving

Device Accountability Log: Device Receipt

Date Received
Beschrijving

Date Received

Datatype

date

Batch # or Device Type
Beschrijving

Batch # or Device Type

Datatype

text

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

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

Datatype

integer

Received by (staff initials)
Beschrijving

Received by (staff initials)

Datatype

text

Device Accountability Log: Device Use
Beschrijving

Device Accountability Log: Device Use

Date used
Beschrijving

Date used

Datatype

date

Subject Study ID
Beschrijving

Subject Study ID

Datatype

integer

Dispensed by (staff initials)
Beschrijving

Dispensed by (staff initials)

Datatype

text

Device Accountability Log: Device Return/Repair/Destruction
Beschrijving

Device Accountability Log: Device Return/Repair/Destruction

Device Position
Beschrijving

RET = Returned DES = Destroyed REP = Repaired

Datatype

text

Date of final Device Disposition
Beschrijving

Date of final Device Disposition

Datatype

date

Reason
Beschrijving

Reason

Datatype

text

Confirmed by (staff initials)
Beschrijving

Confirmed by (staff initials)

Datatype

text

Comments
Beschrijving

Comments

Datatype

text

Terug naar het begin van de pagina

Similar models

Device Accountability Log: CRF Wisconsin Madison

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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
Terug naar het begin van de pagina 

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