ID

16611

Beschreibung

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

Stichworte

  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 -
Hochgeladen am

26. Juli 2016

DOI

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Lizenz

Creative Commons BY-NC 3.0

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Device Accountability Log: CRF Wisconsin Madison

Device Accountability Log: CRF Wisconsin Madison

Header
Beschreibung

Header

PI Name
Beschreibung

PI Name

Datentyp

text

Protocol or IRB Number
Beschreibung

Protocol or IRB Number

Datentyp

integer

Protocol Short Title
Beschreibung

Protocol Short Title

Datentyp

text

Number of Page
Beschreibung

Number of Page

Datentyp

integer

Total amount of pages
Beschreibung

Total amount of pages

Datentyp

integer

Device Accountability Log: Device Receipt
Beschreibung

Device Accountability Log: Device Receipt

Date Received
Beschreibung

Date Received

Datentyp

date

Batch # or Device Type
Beschreibung

Batch # or Device Type

Datentyp

text

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

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

Datentyp

integer

Received by (staff initials)
Beschreibung

Received by (staff initials)

Datentyp

text

Device Accountability Log: Device Use
Beschreibung

Device Accountability Log: Device Use

Date used
Beschreibung

Date used

Datentyp

date

Subject Study ID
Beschreibung

Subject Study ID

Datentyp

integer

Dispensed by (staff initials)
Beschreibung

Dispensed by (staff initials)

Datentyp

text

Device Accountability Log: Device Return/Repair/Destruction
Beschreibung

Device Accountability Log: Device Return/Repair/Destruction

Device Position
Beschreibung

RET = Returned DES = Destroyed REP = Repaired

Datentyp

text

Date of final Device Disposition
Beschreibung

Date of final Device Disposition

Datentyp

date

Reason
Beschreibung

Reason

Datentyp

text

Confirmed by (staff initials)
Beschreibung

Confirmed by (staff initials)

Datentyp

text

Comments
Beschreibung

Comments

Datentyp

text

Ähnliche Modelle

Device Accountability Log: CRF Wisconsin Madison

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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