Information:
Error:
ID
16964
Description
ODM derived from: http://research.uic.edu/qip/toolbox/case-report-forms-crf. Template Name: Vital signs. 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)
- 8/17/16 8/17/16 -
Uploaded on
August 17, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Vital signs: UIC Quality Improvement CRF
Vital signs: UIC Quality Improvement CRF
- StudyEvent: ODM
Similar models
Vital signs: 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)
Visit
Item
Visit
boolean
Visit
Item
Visit
text
Completion visit
Item
Completion visit
boolean
1. Time
Item
1. Time
time
CL Item
am (1)
CL Item
pm (2)
2. Height
Item
2. Height
float
CL Item
inches (1)
CL Item
centimeters (2)
Height
Item
Height: Not Done
boolean
3. Weight
Item
3. Weight
float
CL Item
pounds (1)
CL Item
kilograms (2)
Weight
Item
Weight: Not Done
boolean
4. Heart Rate
Item
4. Heart Rate
integer
Heart Rate
Item
Heart Rate: Not Done
boolean
5. Blood pressure
Item
5. Blood pressure: systolic
integer
Blood pressure
Item
Blood pressure: diastolic
integer
Blood pressure
Item
Blood pressure: Not Done
boolean
CL Item
Sitting (1)
CL Item
Supine (2)
CL Item
Standing (3)
6. Temperature
Item
6. Temperature
float
CL Item
°F (1)
CL Item
°C (2)
Temperature
Item
Temperature: Not Done
boolean
CL Item
Oral (1)
CL Item
Tympanic (2)
CL Item
Other (specify) (3)
Source
Item
If Other, please specify
text
7. Respiratory Rate
Item
7. Respiratory Rate: ___/min
integer
Respiratory Rate
Item
Respiratory Rate: Not Done
boolean
Completed by (initials)
Item
Completed by (initials)
text
Date completed
Item
Date completed
date