Information:
Error:
ID
16870
Description
ODM derived from: http://research.uic.edu/qip/toolbox/case-report-forms-crf. Template Name: Inclusion/Exclusion Criteria. 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.
Link
http://research.uic.edu/qip/toolbox/case-report-forms-crf
Keywords
Versions (1)
- 8/11/16 8/11/16 -
Uploaded on
August 11, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Inclusion/Exclusion Criteria: UIC Quality Improvement CRF
Inclusion/Exclusion Criteria: UIC Quality Improvement CRF
- StudyEvent: ODM
Similar models
Inclusion/Exclusion Criteria: UIC Quality Improvement CRF
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Protocol Title
Item
Protocol Title
text
Site Number
Item
Site Number
integer
Subject ID
Item
Subject ID
integer
Visit Date
Item
Visit Date
date
CL Item
Screening (1)
CL Item
Baseline (2)
Inclusion Description
Item
Inclusion Description
text
Inclusion Description
Item
Inclusion description fulfilled
boolean
Exclusion Description
Item
Exclusion Description
text
Exclusion Description
Item
Exclusion description fulfilled
boolean
Did the subject meet the eligibility requirements for this study?
Item
Did the subject meet the eligibility requirements for this study?
boolean
Signature
Item
Signature
text
Date
Item
Date
date
Printed Name
Item
Printed Name
text