ID

16618

Descrição

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

Palavras-chave

  1. 26/07/2016 26/07/2016 -
Transferido a

26 de julho de 2016

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

Device Accountability Log (per subject): CRF Wisconsin Madison

Device Accountability Log (per subject): CRF Wisconsin Madison

Header
Descrição

Header

PI Name
Descrição

PI Name

Tipo de dados

text

Protocol or IRB Number
Descrição

Protocol or IRB Number

Tipo de dados

integer

Protocol Short Title
Descrição

Protocol Short Title

Tipo de dados

text

Subject Initials
Descrição

Subject Initials

Tipo de dados

text

Subject ID
Descrição

Subject ID

Tipo de dados

integer

Number of Page
Descrição

Number of Page

Tipo de dados

integer

Total Number of Pages
Descrição

Total Number of Pages

Tipo de dados

integer

Drug Dispensation & Accountability Log
Descrição

Drug Dispensation & Accountability Log

Lot Number(s)
Descrição

Lot Number(s)

Tipo de dados

integer

Randomization Number
Descrição

Randomization Number

Tipo de dados

integer

Drug Dispensation & Accountability Log: Dispensed to Subject
Descrição

Drug Dispensation & Accountability Log: Dispensed to Subject

Number of Containers Dispensed
Descrição

Number of Containers Dispensed

Tipo de dados

integer

Number of Units Dispensed
Descrição

Number of Units Dispensed

Tipo de dados

integer

Date Dispensed
Descrição

Date Dispensed

Tipo de dados

date

Dispensed by (staff initials)
Descrição

Dispensed by (staff initials)

Tipo de dados

text

Expected Date of First Dose
Descrição

Expected Date of First Dose

Tipo de dados

date

Drug Dispensation & Accountability Log: Returned by Subject
Descrição

Drug Dispensation & Accountability Log: Returned by Subject

Number of Containers Returned
Descrição

Number of Containers Returned

Tipo de dados

integer

Number of units returned
Descrição

Number of units returned

Tipo de dados

integer

Date Returned
Descrição

Date Returned

Tipo de dados

date

Verified by (staff initials)
Descrição

Verified by (staff initials)

Tipo de dados

text

Drug Dispensation & Accountability Log: Compliance
Descrição

Drug Dispensation & Accountability Log: Compliance

Actual number of units used/taken
Descrição

Actual number of units used/taken

Tipo de dados

integer

Estimated number of units to be used/taken
Descrição

Estimated number of units to be used/taken

Tipo de dados

integer

% compliance
Descrição

% compliance

Tipo de dados

integer

Similar models

Device Accountability Log (per subject): CRF Wisconsin Madison

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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
Number of Page
Item
Number of Page
integer
Total Number of Pages
Item
Total Number of Pages
integer
Item Group
Drug Dispensation & Accountability Log
Lot Number(s)
Item
Lot Number(s)
integer
Randomization Number
Item
Randomization Number
integer
Item Group
Drug Dispensation & Accountability Log: Dispensed to Subject
Number of Containers Dispensed
Item
Number of Containers Dispensed
integer
Number of Units Dispensed
Item
Number of Units Dispensed
integer
Date Dispensed
Item
Date Dispensed
date
Dispensed by (staff initials)
Item
Dispensed by (staff initials)
text
Expected Date of First Dose
Item
Expected Date of First Dose
date
Item Group
Drug Dispensation & Accountability Log: Returned by Subject
Number of Containers Returned
Item
Number of Containers Returned
integer
Number of units returned
Item
Number of units returned
integer
Date Returned
Item
Date Returned
date
Verified by (staff initials)
Item
Verified by (staff initials)
text
Item Group
Drug Dispensation & Accountability Log: Compliance
Actual number of units used/taken
Item
Actual number of units used/taken
integer
Estimated number of units to be used/taken
Item
Estimated number of units to be used/taken
integer
% compliance
Item
% compliance
integer

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial