ID

16618

Descrizione

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.

collegamento

https://ictr.wisc.edu/CaseReptTempt

Keywords

versioni (1)
  1. 26/07/16 26/07/16 -
Caricato su

26 luglio 2016

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0
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Device Accountability Log (per subject): CRF Wisconsin Madison

Inglese

Device Accountability Log (per subject): CRF Wisconsin Madison

1 moduli  
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

Subject Initials
Descrizione

Subject Initials

Tipo di dati

text

Subject ID
Descrizione

Subject ID

Tipo di dati

integer

Number of Page
Descrizione

Number of Page

Tipo di dati

integer

Total Number of Pages
Descrizione

Total Number of Pages

Tipo di dati

integer

Drug Dispensation & Accountability Log
Descrizione

Drug Dispensation & Accountability Log

Lot Number(s)
Descrizione

Lot Number(s)

Tipo di dati

integer

Randomization Number
Descrizione

Randomization Number

Tipo di dati

integer

Drug Dispensation & Accountability Log: Dispensed to Subject
Descrizione

Drug Dispensation & Accountability Log: Dispensed to Subject

Number of Containers Dispensed
Descrizione

Number of Containers Dispensed

Tipo di dati

integer

Number of Units Dispensed
Descrizione

Number of Units Dispensed

Tipo di dati

integer

Date Dispensed
Descrizione

Date Dispensed

Tipo di dati

date

Dispensed by (staff initials)
Descrizione

Dispensed by (staff initials)

Tipo di dati

text

Expected Date of First Dose
Descrizione

Expected Date of First Dose

Tipo di dati

date

Drug Dispensation & Accountability Log: Returned by Subject
Descrizione

Drug Dispensation & Accountability Log: Returned by Subject

Number of Containers Returned
Descrizione

Number of Containers Returned

Tipo di dati

integer

Number of units returned
Descrizione

Number of units returned

Tipo di dati

integer

Date Returned
Descrizione

Date Returned

Tipo di dati

date

Verified by (staff initials)
Descrizione

Verified by (staff initials)

Tipo di dati

text

Drug Dispensation & Accountability Log: Compliance
Descrizione

Drug Dispensation & Accountability Log: Compliance

Actual number of units used/taken
Descrizione

Actual number of units used/taken

Tipo di dati

integer

Estimated number of units to be used/taken
Descrizione

Estimated number of units to be used/taken

Tipo di dati

integer

% compliance
Descrizione

% compliance

Tipo di dati

integer

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Similar models

Device Accountability Log (per subject): CRF Wisconsin Madison

1 moduli
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
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
Ritorna all'inizio della pagina 

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