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Inclusion/Exclusion Criteria: UIC Quality Improvement CRF

1 forms  
General Information
Description

General Information

Protocol Title
Description

Protocol Title

Data type

text

Site Number
Description

Site Number

Data type

integer

Subject ID
Description

Subject ID

Data type

integer

Visit Date
Description

Visit Date

Data type

date

Study Visit
Description

Study Visit

Data type

text

Inclusion Criteria
Description

Inclusion Criteria

Inclusion Description
Description

Inclusion Description

Data type

text

Inclusion description fulfilled
Description

Inclusion Description

Data type

boolean

Exclusion Criteria
Description

Exclusion Criteria

Exclusion Description
Description

Exclusion Description

Data type

text

Exclusion description fulfilled
Description

Exclusion Description

Data type

boolean

Results
Description

Results

Did the subject meet the eligibility requirements for this study?
Description

Did the subject meet the eligibility requirements for this study?

Data type

boolean

Signature
Description

Signature

Data type

text

Date
Description

Date

Data type

date

Printed Name
Description

Printed Name

Data type

text

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Similar models

Inclusion/Exclusion Criteria: UIC Quality Improvement CRF

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General Information
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
Study Visit
text
Study Visit
Code List
Study Visit
CL Item
Screening (1)
CL Item
Baseline (2)
Item Group
Inclusion Criteria
Inclusion Description
Item
Inclusion Description
text
Inclusion Description
Item
Inclusion description fulfilled
boolean
Item Group
Exclusion Criteria
Exclusion Description
Item
Exclusion Description
text
Exclusion Description
Item
Exclusion description fulfilled
boolean
Item Group
Results
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
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