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ID

16864

Descrizione

ODM derived from: http://research.uic.edu/qip/toolbox/case-report-forms-crf. Template Name: Visit Checklist. QIP Case Report Forms, UIC Quality Improvement CRF, Office of the Vice Chancellor for Research. Center for Clinical and Translational Science, UIC University of Illinois at Chicago.

collegamento

http://research.uic.edu/qip/toolbox/case-report-forms-crf

Keywords

  1. 11/08/16 11/08/16 -
Caricato su

11 agosto 2016

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0

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    Visit Checklist: UIC Quality Improvement CRF

    Visit Checklist: UIC Quality Improvement CRF

    Visit Checklist
    Descrizione

    Visit Checklist

    Protocol Title
    Descrizione

    Protocol Title

    Tipo di dati

    text

    Site Number
    Descrizione

    Site Number

    Tipo di dati

    integer

    Subject ID
    Descrizione

    Subject ID

    Tipo di dati

    integer

    Visit Date
    Descrizione

    Visit Date

    Tipo di dati

    date

    1. Did the subject attend this visit?
    Descrizione

    1. Attendance

    Tipo di dati

    text

    2. Study Visit: Date of Informed Consent Signed
    Descrizione

    2. Study Visit

    Tipo di dati

    date

    Study Visit: Demographics
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit: Medical History
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit: Vital Signs
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit: Physical Exam
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit: Prior and Concomitant Medication
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit: Inclusion/Exclusion Criteria
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit: Randomization
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    Study Visit Enrollment
    Descrizione

    Study Visit

    Tipo di dati

    boolean

    3. Is the subject continuing in the study?
    Descrizione

    If yes, remember to complete a Study Completion Form. If no, schedule next visit.

    Tipo di dati

    boolean

    Comments
    Descrizione

    Comments

    Tipo di dati

    text

    Completed by (initials)
    Descrizione

    Completed by

    Tipo di dati

    text

    Date completed
    Descrizione

    Date completed

    Tipo di dati

    date

    Similar models

    Visit Checklist: UIC Quality Improvement CRF

    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Visit Checklist
    Protocol Title
    Item
    Protocol Title
    text
    Site Number
    Item
    Site Number
    integer
    Subject ID
    Item
    Subject ID
    integer
    Visit Date
    Item
    Visit Date
    date
    Item
    1. Did the subject attend this visit?
    text
    Code List
    1. Did the subject attend this visit?
    CL Item
    Yes (If yes, continue) (1)
    CL Item
    No (If no, enter comments below) (2)
    2. Study Visit
    Item
    2. Study Visit: Date of Informed Consent Signed
    date
    Study Visit
    Item
    Study Visit: Demographics
    boolean
    Study Visit
    Item
    Study Visit: Medical History
    boolean
    Study Visit
    Item
    Study Visit: Vital Signs
    boolean
    Study Visit
    Item
    Study Visit: Physical Exam
    boolean
    Study Visit
    Item
    Study Visit: Prior and Concomitant Medication
    boolean
    Study Visit
    Item
    Study Visit: Inclusion/Exclusion Criteria
    boolean
    Study Visit
    Item
    Study Visit: Randomization
    boolean
    Study Visit
    Item
    Study Visit Enrollment
    boolean
    3. Is the subject continuing in the study?
    Item
    3. Is the subject continuing in the study?
    boolean
    Comments
    Item
    Comments
    text
    Completed by
    Item
    Completed by (initials)
    text
    Date completed
    Item
    Date completed
    date

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