ID

16611

Descrizione

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.

collegamento

https://ictr.wisc.edu/CaseReptTempt

Keywords

  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 -
Caricato su

26 luglio 2016

DOI

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Licenza

Creative Commons BY-NC 3.0

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Device Accountability Log: CRF Wisconsin Madison

Device Accountability Log: CRF Wisconsin Madison

Header
Descrizione

Header

PI Name
Descrizione

PI Name

Tipo di dati

text

Protocol or IRB Number
Descrizione

Protocol or IRB Number

Tipo di dati

integer

Protocol Short Title
Descrizione

Protocol Short Title

Tipo di dati

text

Number of Page
Descrizione

Number of Page

Tipo di dati

integer

Total amount of pages
Descrizione

Total amount of pages

Tipo di dati

integer

Device Accountability Log: Device Receipt
Descrizione

Device Accountability Log: Device Receipt

Date Received
Descrizione

Date Received

Tipo di dati

date

Batch # or Device Type
Descrizione

Batch # or Device Type

Tipo di dati

text

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

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

Tipo di dati

integer

Received by (staff initials)
Descrizione

Received by (staff initials)

Tipo di dati

text

Device Accountability Log: Device Use
Descrizione

Device Accountability Log: Device Use

Date used
Descrizione

Date used

Tipo di dati

date

Subject Study ID
Descrizione

Subject Study ID

Tipo di dati

integer

Dispensed by (staff initials)
Descrizione

Dispensed by (staff initials)

Tipo di dati

text

Device Accountability Log: Device Return/Repair/Destruction
Descrizione

Device Accountability Log: Device Return/Repair/Destruction

Device Position
Descrizione

RET = Returned DES = Destroyed REP = Repaired

Tipo di dati

text

Date of final Device Disposition
Descrizione

Date of final Device Disposition

Tipo di dati

date

Reason
Descrizione

Reason

Tipo di dati

text

Confirmed by (staff initials)
Descrizione

Confirmed by (staff initials)

Tipo di dati

text

Comments
Descrizione

Comments

Tipo di dati

text

Similar models

Device Accountability Log: CRF Wisconsin Madison

Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
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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