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

  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

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

Visit
Description

Visit

Data type

boolean

Visit
Description

Visit

Data type

text

Completion visit
Description

Completion visit

Data type

boolean

Vital signs
Description

Vital signs

1. Time
Description

1. Time

Data type

time

Time
Description

Time

Data type

text

2. Height
Description

2. Height

Data type

float

Height
Description

Height

Data type

text

Height: Not Done
Description

Height

Data type

boolean

3. Weight
Description

3. Weight

Data type

float

Weight
Description

Weight

Data type

text

Weight: Not Done
Description

Weight

Data type

boolean

4. Heart Rate
Description

4. Heart Rate

Data type

integer

Measurement units
  • bpm
bpm
Heart Rate: Not Done
Description

Heart Rate

Data type

boolean

5. Blood pressure: systolic
Description

5. Blood pressure

Data type

integer

Blood pressure: diastolic
Description

Blood pressure

Data type

integer

Blood pressure: Not Done
Description

Blood pressure

Data type

boolean

5.a BP Position
Description

5.a BP Position

Data type

text

6. Temperature
Description

6. Temperature

Data type

float

Temperature
Description

Temperature

Data type

text

Temperature: Not Done
Description

Temperature

Data type

boolean

6.a Source
Description

6.a Source

Data type

text

If Other, please specify
Description

Source

Data type

text

7. Respiratory Rate: ___/min
Description

7. Respiratory Rate

Data type

integer

Respiratory Rate: Not Done
Description

Respiratory Rate

Data type

boolean

Completed by (initials)
Description

Completed by (initials)

Data type

text

Date completed
Description

Date completed

Data type

date

Similar models

Vital signs: UIC Quality Improvement CRF

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
Code List
Study Visit
CL Item
Screening (1)
CL Item
Baseline (2)
Visit
Item
Visit
boolean
Visit
Item
Visit
text
Completion visit
Item
Completion visit
boolean
Item Group
Vital signs
1. Time
Item
1. Time
time
Item
Time
text
Code List
Time
CL Item
am (1)
CL Item
pm (2)
2. Height
Item
2. Height
float
Item
Height
text
Code List
Height
CL Item
inches (1)
CL Item
centimeters (2)
Height
Item
Height: Not Done
boolean
3. Weight
Item
3. Weight
float
Item
Weight
text
Code List
Weight
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
Item
5.a BP Position
text
Code List
5.a BP Position
CL Item
Sitting (1)
CL Item
Supine (2)
CL Item
Standing (3)
6. Temperature
Item
6. Temperature
float
Item
Temperature
text
Code List
Temperature
CL Item
°F (1)
CL Item
°C (2)
Temperature
Item
Temperature: Not Done
boolean
Item
6.a Source
text
Code List
6.a Source
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

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