Información:
Error:
ID
16966
Descripción
ODM derived from: http://research.uic.edu/qip/toolbox/case-report-forms-crf. Template Name: Prior and Concomitant Medications. 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
Palabras clave
Versiones (1)
- 17/8/16 17/8/16 -
Subido en
17 de agosto de 2016
DOI
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Licencia
Creative Commons BY-NC 3.0
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Prior and Concomitant Medications: UIC Quality Improvement CRF
Prior and Concomitant Medications: UIC Quality Improvement CRF
- StudyEvent: ODM
Similar models
Prior and Concomitant Medications: UIC Quality Improvement CRF
- StudyEvent: ODM
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
Prior and Concomitant Medications
Item
Were any Concomitant medications taken by the subject ___ days before or during the study? If Yes, record below.
text
Prior and Concomitant Medications
Item
If yes, how many days before?
integer
Prior and Concomitant Medications
Item
Prior and Concomitant Medications: No
boolean
Medication
Item
Medication
text
Dose
Item
Dose
text
Route
Item
Route (see Description)
integer
Route
Item
Route: If Other, please specify
text
Frequency
Item
Frequency (see Description)
integer
Frequency
Item
Frequency: If Other, please specify
text
Indication
Item
Indication
text
Start Date
Item
Start Date
date
Stop Date
Item
Stop Date OR Check If continuing at study end
date
CL Item
Yes (1)
CL Item
No (2)
Specification
Item
If Yes, specify event
text