Information:
Error:
ID
16977
Description
ODM derived from: http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx. Template Name: Demographics. University of Alberta, Quality Management in Clinical Research. Copyright: 2002-2016 University of Alberta.
Link
http://www.qmcr.ualberta.ca/en/ToolsandTemplates/CaseReportFormCRFTemplates.aspx
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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Demographics: CRF QMCR University of Alberta
Demographics: CRF QMCR University of Alberta
- StudyEvent: ODM
Similar models
Demographics: CRF QMCR University of Alberta
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Study Name
Item
Study Name
text
Site Number
Item
Site Number
integer
Pt_ID
Item
Pt_ID
integer
Visit Date
Item
Visit Date
date
CL Item
Screening (1)
CL Item
Baseline (2)
CL Item
Female (1)
CL Item
Male (2)
2. Date of Birth
Item
2. Date of Birth
date
CL Item
American Indian or Alaska Native (1)
CL Item
Asian (2)
CL Item
Black or African-American (3)
CL Item
Native Hawaiian or Pacific Islander (4)
CL Item
White (5)
CL Item
More than one race (6)
CL Item
Unknown or not reported (7)
CL Item
Hispanic or Latino (1)
CL Item
Not Hispanic or Latino (2)
CL Item
Unknown or not reported (3)
Date Informed Consent Signed
Item
Date Informed Consent Signed
date
Investigator Signature
Item
Investigator Signature
text
Date
Item
Date
date