Engels

Inclusion/Exclusion Criteria: UIC Quality Improvement CRF

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General Information
Beschrijving

General Information

Protocol Title
Beschrijving

Protocol Title

Datatype

text

Site Number
Beschrijving

Site Number

Datatype

integer

Subject ID
Beschrijving

Subject ID

Datatype

integer

Visit Date
Beschrijving

Visit Date

Datatype

date

Study Visit
Beschrijving

Study Visit

Datatype

text

Inclusion Criteria
Beschrijving

Inclusion Criteria

Inclusion Description
Beschrijving

Inclusion Description

Datatype

text

Inclusion description fulfilled
Beschrijving

Inclusion Description

Datatype

boolean

Exclusion Criteria
Beschrijving

Exclusion Criteria

Exclusion Description
Beschrijving

Exclusion Description

Datatype

text

Exclusion description fulfilled
Beschrijving

Exclusion Description

Datatype

boolean

Results
Beschrijving

Results

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

Did the subject meet the eligibility requirements for this study?

Datatype

boolean

Signature
Beschrijving

Signature

Datatype

text

Date
Beschrijving

Date

Datatype

date

Printed Name
Beschrijving

Printed Name

Datatype

text

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Similar models

Inclusion/Exclusion Criteria: UIC Quality Improvement CRF

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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